EFFECTIVENESS OF PROGRESSIVE MUSCLE...
Transcript of EFFECTIVENESS OF PROGRESSIVE MUSCLE...
EFFECTIVENESS OF PROGRESSIVE MUSCLE
RELAXATION TECHNIQUE ON ANXIETY AMONG
SPOUSE OF ALCOHOLIC DEPENDENTS AT
DEADDICTION CENTRE, GRH, MADURAI.
M.Sc (NURSING) DEGREE EXAMINATION
BRANCH - V MENTAL HEALTH NURSING
COLLEGE OF NURSING
MADURAI MEDICAL COLLEGE, MADURAI -20.
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,
CHENNAI - 600 032.
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
APRIL 2016
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EFFECTIVENESS OF PROGRESSIVE MUSCLE
RELAXATION TECHNIQUE ON ANXIETY AMONG
SPOUSE OF ALCOHOLIC DEPENDENTS AT
DEADDICTION CENTRE, GRH, MADURAI.
Approved by Dissertation committee on 13.11.2014
Expert in Nursing Research ___________________________
Mrs.S.POONGUZHALI, M.Sc (N), M.A,M.B.A., Ph.D., Principal, College of Nursing, Madurai Medical College, Madurai.
Clinical Speciality expert ________________
Mrs.S.RAJAMANI, M.Sc (N), M.B.A., M.Sc (Psy), Ph.D., Lecturer, Department of Mental Health Nursing , College of Nursing, Madurai Medical College, Madurai.
Medical Expert ___________________
Dr.T.KUMANAN, M.D.,DPM., Professor and H.O.D, Department of Psychiatry, Madurai Medical College, Madurai.
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,
CHENNAI- 600 032.
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
APRIL 2016
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CERTIFICATE
This is to certify that this dissertation titled, “EFFECTIVENESS OF
PROGRESSIVE MUSCLE RELAXATION TECHNIQUE ON ANXIETY
AMONG SPOUSE OF ALCOHOLIC DEPENDENTS AT DEADDICTION
CENTRE, GRH, MADURAI” is a bonafide work done by
Mr.P.S.RAJARAJENDRAN, M.Sc (N) Student, College of Nursing, Madurai
Medical College, Madurai - 20, submitted to THE TAMILNADU DR.M.G.R.
MEDICAL UNIVERSITY, CHENNAI in partial fulfillment of the university rules
and regulations towards the award of the degree of MASTER OF SCIENCE IN
NURSING, Branch V, Mental Health Nursing, under our guidance and supervision
during the academic period from 2014-2016.
Mrs.S.POONGUZHALI, M.Sc (N), M.A., Dr.M.R.VAIRAMUTHU RAJU, M.D (GM).,
M.B.A(HM)., Ph.D., DEAN,
PRINCIPAL, MADURAI MEDICAL COLLEGE,
COLLEGE OF NURSING, MADURAI-20.
MADURAI MEDICAL COLLEGE,
MADURAI-20.
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CERTIFICATE
This is to certify that the dissertation entitled “EFFECTIVENESS OF
PROGRESSIVE MUSCLE RELAXATION TECHNIQUE ON ANXIETY
AMONG SPOUSE OF ALCOHOLIC DEPENDENTS AT DEADDICTION
CENTRE, GRH, MADURAI” is a bonafide work done
Mr.P.S.RAJARAJENDRAN, M.Sc (N) Student, College of Nursing, Madurai
Medical College, Madurai- 20, in partial fulfillment of the University rules and
regulations for award of the degree of MASTER OF SCIENCE IN NURSING,
Branch V, Mental Health Nursing, under our guidance and supervision during the
academic year 2014-2016.
Name & Signature of the Guide _________________________
Mrs.S.RAJAMANI, M.Sc (N), M.B.A(HM).,M.Sc (Psy)., Ph.D., Lecturer, Department of Mental Health Nursing, College of Nursing, Madurai Medical College, Madurai.20
Name & Signature of the Head of Department ______________________
Mrs.S.POONGUZHALI, M.Sc (N), M.A, M.B.A(HM)., Ph.D., Principal, College of Nursing, Madurai Medical College, Madurai.20
Name & Signature of the Dean __________________________
Dr.M.R.VAIRAMUTHU RAJU, M.D(G.M)., Dean, Madurai Medical College, Madurai-20
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ACKNOWLEDGEMENT
“Acknowledge him in all your ways and he shall direct your paths”-Pro 3:6
Any dissertation work is a corporate endeavor necessitating the assistance of
more than one. My attempt to bring out this assignment is therefore teamwork. The
satisfaction and pleasure that accompany the successful completion of any task would
be incomplete without mentioning the people who made it possible, whose constant
guidance encouragement, rewards and any effort with success. I the investigator of
this study owe deep sense of gratitude to all those who have contributed to the
successful completion of this study.
Many helping hands have smoothened every step of this dissertation, first of
all I praise and thank the lord almighty for his abundant grace, blessing, support,
wisdom, and strength throughout this endeavor.
I wish to acknowledge my sincere and heartfelt gratitude to all my well
wishers for their continuous support, strength and guidance from the beginning to the
end of this research study.
I extend my sincere thanks to Dr.M.R.Vairamuthu Raja M.D,(GM) Dean,
Madurai Medical College, Madurai for providing necessary facilities to undertake the
study.
I wish to express my deep sense of gratitude and heartfelt thanks to
Mrs.S. Poonguzhali M.Sc (N), M.A, M.B.A(HM), Ph.D Principal, College of
Nursing, Madurai Medical College, Madurai for her guidance and suggestions to
carry out the study.
I extend my sincere thanks to Captain Dr. B.Santhakumar, M.Sc (FSc).,
M.D,(F`M), PGDMLE., Dip N.B(F.M)., former Dean , Madurai Medical College,
Madurai for his acceptance and approval of the study.
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I express my heartfelt and faithful thanks to Mrs. S. Rajamani.M.Sc (N),
M.B.A.,(HM), M.Sc (Psy),, Ph.D., Lecturer, Department of Mental Health Nursing,
College of Nursing, Madurai Medical College, Madurai for her hard work, efforts,
interest to mould this study in successful way, her easy approachability and
understanding nature laid a strong foundation on research. It is very essential to
mention her wisdom and helping nature has made my research a lively and everlasting
one.
My deep sense of gratitude to Dr.T.Kumanan M.D, DPM, Professor and
H.O.D, Department of psychiatry, Government Rajaji Hospital, Madurai, for his
timely help and guidance.
I wish to express my sincere thanks to Mr. N.Suresh kumar.M.A., M.Phil.,
(Clinical psychologist) Assistant professor , Department of psychiatry, Government
Rajaji Hospital Madurai, for his excellent guidance and support for the successful
completion of the study.
I am thankful to Mr.S.Kalaiselvan, M.A., B.LISc., Librarian, College of
Nursing , Madurai Medical College, Madurai for the guidance in referring the books
and journals.
I offer my earnest gratitude to all Faculty of College of Nursing, Madurai
Medical College, Madurai for their assistance and moral support.
I extend my sincere thanks to statistician for his expert advice and guidance
in the course of analyzing various data involved in this study.
My heartfelt thanks to Dr.N.Balasubramaniam, M.A.,(Tamil) MPhil.,
Ph.D., for editing the manuscript in tamil.
My immense thanks to Miss.R. Divya priyadarsini, M.A., B.Ed,(English)
for editing the manuscript in English.
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I extent my thanks to all my classmates especially Mental Health Nursing Post
Graduates and my lovable seniors.
I wish to offer my earnest gratitude to our Rajayogini B.K. Meenakshi,
subzonal Incharge, Rajyoga mediation centre, Madurai, divine brother
B.K.Balamurali, co-ordinator, B.K. Uma, co-ordinator, and B.K.Senthamarai,
senior Rajyoga teacher, B.K.Gnana soundari, senior Rajyoga teacher Thanjavur, for
their divine support throughout the study.
This acknowledgement will not be complete if I fail to offer my special
heartfelt thanks, and words are not adequate to express my gratitude to my beloved
parents Mr.P.Sangilimuthu and Mrs.S.Dhanaklakshmi and my sister
Mrs.S.Senthamil pavai Arjunan, and my brothers Mr.S.Muthamizh vendhan,
Mr.S. Alagu tamil and all dear my friends who extended their helping hands and
supporting me in all means round the clock right from the beginning till the end in
bringing out this Dissertation.
I extent my thanks to Laser point staff for his help in preparing the manuscript.
Last but not least I thanks to all the spouse of alcoholic dependents who
participated in this study and also for their cooperation throughout the study.
.
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ABSTRACT
Title: “Effectiveness of progressive muscle relaxation technique on anxiety
among spouse of alcoholic dependents at deaddiction centre GRH, Madurai.
Objectives: To assess the level of anxiety among spouse of alcoholic dependents, To
evaluate the effectiveness of progressive muscle relaxation technique on anxiety
among spouse of alcoholic dependents, To associate the level of anxiety among
spouse of alcoholic dependents at deaddiction centre GRH, Madurai and their selected
socio demographic variables. Hypotheses: There is a significant difference between
pretest and posttest level of anxiety among spouse of alcoholic dependents. There is
a significant association between the level of anxiety and their selected socio
demographic variables. Conceptual framework : Modified Roy’s adaptation model
was used for this study. Methodology: A Pre- experimental one group pretest posttest
design was used. 40 spouses of alcoholic dependents were selected by consecutive
sampling method. Pretest was conducted by using Hamilton anxiety scale on day1 ,
progressive muscle relaxation was given for 30 minutes twice a day for 5 consecutive
days . Post test was assessed on 6 th day by using same scale. Results: Progressive
muscle relaxation reduced the anxiety level among spouse of alcoholic dependents at
deaddiction centre. There was a significant association between posttest level of
anxiety and age, educational status, and duration of alcohol consumption.
Conclusion: Progressive muscle relaxation is cost effective, non-invasive, non –
pharmacological complementary therapy to reduce anxiety among spouse of alcoholic
dependents.
Key words: Progressive muscle relaxation, anxiety, spouse of alcoholic dependents.
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TABLE OF CONTENTS
CHAPTERNO TITLE PAGE
NO1. INTRODUCTION
1.1 Need for the study
1.2 Statement of the problem
1.3 Objectives
1.4 Hypotheses
1.5 Operational definitions
1.6. Assumption
1.7 Delimitation
1.8 Projected outcome
1
7
10
10
11
11
12
12
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2. REVIEW OF LITERATURE
2. 1. Literature related to spouse of alcoholic dependents
and anxiety
2.2. Literature related to effectiveness of progressive
muscle relaxation technique on anxiety
2.3. Literature related to effectiveness of progressive
muscle relaxation technique on anxiety among
spouse of alcoholic dependents
2.4 Conceptual frame work
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14
17
24
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3. RESEARCH METHODOLOGY
3.1 Research approach
3.2 Research design
3.3 Variables
3.4 Setting of the study
3.5 Population
3.6 Sample
3.7 Sample size
3.8 Sampling technique
3.9 Criteria for sample selection
3.10 Research tool and technique
32
32
32
32
33
33
33
33
33
34
34
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CHAPTERNO TITLE PAGE
NO3.11 Scoring procedure
3.12 Validity of the tool
3.13 Reliability of the tool
3.14 Pilot study
3.15 Data collection procedure
3.16 Plan for Data analysis
3.17 Protection of human subjects
3.18 Schematic Representation of Research
methodology
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35
35
35
36
37
38
39
4. ANALYSIS AND INTERPRETATION OF DATA 40
5. DISCUSSION 55
6. SUMMARY AND CONCLUSION
6.1 Summary
6.2 Major Findings of the study
6.3 Conclusion
6.4 Implications for nursing
6.5 Recommendations for further research
72
72
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76
77
REFERENCES 79
APPENDICES 86
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LIST OF TABLES
TABLE NO TITLE PAGE
NO
1.
Frequency and Percentage Distribution of spouse of alcoholic
dependents according to their selected socio demographic
variables 41
2.Frequency and percentage distribution of the spouse of alcoholic
dependents according to the level of anxiety 55
3.Effectiveness of progressive muscle relaxation technique on
anxiety among spouse of alcoholic dependents 57
4.Comparison of pretest and posttest mean anxiety score among
spouse of alcoholic dependents 58
5.
Association between the level of anxiety among spouse of
alcoholic dependents and their selected socio demographic
variables 60
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LIST OF FIGURES
FIGURE
NOTITLE
PAGE
NO
1. Conceptual framework 31
2 Schematic representation of the study 39
3. Mean and Standard Deviation of pretest and posttest level of
anxiety among spouse of alcoholic dependents 44
4. Comparison of pretest and posttest mean anxiety score among
spouse of alcoholic dependents 45
5. Distribution of spouse of alcoholic dependents according to
Educational status 46
6. Distribution of spouse of alcoholic dependents according to
Occupation 47
7 Distribution of spouse of alcoholic dependents according to
Family monthly income 48
8 Distribution of spouse of alcoholic dependents according to
Type of family 49
9 Distribution of spouse of alcoholic dependents according to
Residential status 50
10. Distribution of spouse of alcoholic dependents according to
Number of children 51
11 Distribution of spouse of alcoholic dependents according to
the Duration of alcohol consumption 52
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12. Distribution of spouse of alcoholic dependents according to
any physical illness 53
13. Distribution of spouse of alcoholic dependents according to
previous relaxation experience 54
14. Distribution of spouse of alcoholic dependents according to
their level of anxiety 56
15. Comparison of pretest and posttest mean anxiety score among
spouse of alcoholic dependents 59
16. Association between level of anxiety reduction score and
spouse age 62
17. Association between level of anxiety reduction score and
education status 63
18. Association between level of anxiety reduction score and
duration of alcohol consumption 64
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LIST OF APPENDICES
APPENDIX
NO TITLE
PAGE
NO
I Ethical committee approval letter. 86
II Letter seeking permission for validation of content and
tool
88
III Content validity certificates 89
IV Informed consent form. 94
V
Letter seeking and granting permission to conduct the
pilot study at deaddiction centre, Government Rajaji
Hospital, Madurai.
95
VI
Letter seeking and granting permission to conduct the
study at deaddiction centre, Government Rajaji
Hospital, Madurai.
96
VII Socio demographic tool - English 98
VIII Research Tool – English. 100
IX Socio demographic tool- Tamil 102
X Research Tool – Tamil. 104
XI English Editing Certificate. 106
XII Tamil Editing Certificate 107
XIII Intervention - Progressive muscle relaxation technique
-English
108
XIVIntervention - Progressive muscle relaxation technique -
Tamil
111
XVTraining Certificate for Progressive muscle relaxation
technique.
114
XVI Photographs. 115
Introduction
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CHAPTER I
INTRODUCTION
“Mankind has used two powerful weapons to destroy its own powers and
enjoyment, wrong indulgence and wrong abstinence’’ -sri Aurobindo
An alcoholic beverage is a drink which contains a substantial amount of the
psychoactive drug ethanol (informally called alcohol). It is one of the most widely
used recreational drugs in the world. In the United States 89% of adults have drunk
alcohol at some point in time, 70% have drunk in the last year and 56% in the last
month. The concentration of alcohol in a beverage is usually stated as the percentage
of alcohol by volume (ABV, the number of ml of pure ethanol in 100 ml of beverage)
or as proof. Historically, this was the most dilute spirit. A spirit which contains a very
high level of alcohol and does not contain any added flavoring is commonly called a
neutral spirit. Generally, any distilled alcoholic beverage of 170 proof or higher is
considered to be a neutral spirit.
Alcohol abuse is more or less a universal problem. A number of mythological
and religious books have highlighted the role it played in society. The pattern of
drinking in India had undergone a change from occasional and ritualistic use to being
a social event. Today, the common purpose of consuming alcohol is to get drunk.
These developments have raised concerns about the health and the social
consequences of excessive drinking. The difficulty is that once a man starts drinking
he becomes addicted to it and goes on increasing its dose which has a very harmful
effect both on the individual as well as the society.
Drinking alcohol plays an important social role in most cultures. Alcohol has
potential for abuse and physical dependence. Addiction to alcohol is a family problem
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and is a major source of disharmony within family members. Family disruption
related to alcoholism is a serious ,complex and pervasive social problem. Alcoholism
linked to violence ,disrupted family roles, and impaired family communication and
partly to physical and psychological illness that occurs not only to the alcoholic
clients bit also to their family members.
The World Health Organization (2012) shows that there are an estimated 140
million alcoholics around the world. In an alarming revelation, the Global Status
report on alcohol and health 2014, released by the World Health Organization (WHO)
states that the amount of alcohol consumption has raised in India between the periods
of 2008 to 2012. The data was compiled taking into account individuals over the age
of 15 and above, who consumed alcohol. According to the report, around 30% of the
total population of India consumed alcohol in the year 2010. 93% of alcohol was
consumed in the form of spirits, followed by beer with 7% and less than 1% of the
population consumed wine. The per capita consumption of alcohol in the country
increased from 1.6 liters from the period of 2003-2005, to 2.2 liters from the period of
2010-2012.
A recent National Household survey Drug and alcohol use in India, recorded
alcohol use in 51% of adult males. The collective review reveals that nearly 30-35%
of adult men and approximately 5% of adult women consume alcohol. The sales
figures of the Tamil Nadu State Marketing Corporation (Tasmac), the government-
owned monopoly liquor retailer, show that liquor consumption increased by 18% in
2010-11 with the sale of 4.8 crore cases of hard liquor. In 2001-12 up to December,
the growth in sales is 11% compared to the same period last year, with three more
months to go for end of the fiscal year. The number of people coming into the bracket
of permissible age for consuming alcohol is increasing every year. Nearly 1of 3 adult
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males consumes alcohol. In Tamilnadu 25-26% of adult male consume alcohol and
among them 68.3% were lifetime abstainers. The 2012 reports of the Madurai branch
Tamil Nadu State Marketing Corporation (Tasmac), shows that liquor consumption
increased by 12% .On regard of the Government Hospitals in the Madurai district.
The Government Rajaji Hospital have an annual census of 5325 alcoholics were
attending the outpatient department per month and an average of 62-68 patients were
admitted in de-addiction ward per month.
Hence in India, the survey conducted reveals the problems associated with
intake of alcohol include spousal assaults 32%,spousal abuse 20%, child abuse 18%,
suicides 30% in the percentage listed, the weight age is much focused on the spousal
abuse and assaults.
The non –profit National Healthy marriage resource Center (NHMRC) Says that ,
Alcohol abuse increases the feelings of marital distress. Individuals in
marriages in which one or both spouses are alcoholics report higher levels of
marital distress or trouble than do married individuals who are not married to
alcoholics.
Alcohol abuse decreases marital satisfaction because it decreases the ability to
participate in everyday household tasks and responsibilities, more negative
and hostile communication, more expression of anger ,and less warmth and
unity in the relationship.
Even though Alcoholism is a family problem, husband’s drinking adversely
affected the wives health, such that wives suffered from various disorders such as
insomnia, depression, and neurosis.
Wives of alcoholics are always in anxiety situation, which gives them
frustration ,agony, emotional disturbances and disturbed personality ,and gradually
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they become neurotic patients or develop personality or adjustment problems. Early
studies of the wives of alcoholics in a family agency setting described them as often
equally as sick as their husbands with a need to dominate, to suffer to punish .Such a
wife and frequently the daughter of an alcoholic father may also suffer from feelings
of basic anxiety and inadequacy which can be denied or assuaged by feeling superior
to her husband.
Montgomery and Johnson (1992) reported that historically wives of
alcoholics have been described as having disturbed pathological personalities that
were instrumental in maintaining their husband’s drinking. More researches have
tended to support the view that the behavior of these women reflects their stressful
circumstances.
James and Goldman (1971) found out that the wives used all sorts of coping,
they themselves were more quarrelsome, they felt angry , they felt hopelessness on
other occasions ,they adopted a strategy of withdrawing , or avoiding the husband
altogether , they had tried to get drunk themselves to show them what it was like or
they had locked the husband out of the house.
Drewery, J. and Rae (1969) report that the interpersonal relationship between
the alcoholic and his wife is characterized by a clear evidence of conflicting
dependence –independence needs. The weight of the evidence favours the
interpretation that it is the patient’s neurotic difficulties rather than any
psychopathology in his wife, which has determined the interpersonal dilemma.
Lewis (1937) endeavored to link the wives personality to the husband’s
alcoholism. He believed that wives of alcohol dependent individuals found an outlet
for aggressive impulses in their marital relationship with men who are dependent and
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force her to punish him. Both partners alternated between ‘Masculine’ and ‘Feminine’
roles.
The spouse of alcoholics are more for emotional and psychological
disturbances. One of the main psychological disturbances is anxiety. Anxiety is a
generalized mood condition that can often occur without an identifiable triggering
stimulus. Physical effects of anxiety may include heart palpitations , muscle weakness
,and tension, fatigue , nausea , shortness of breath , increased sweating, increased
blood flow to the major muscle groups, and inhibition in the immune and digestive
functions. External symptoms of anxiety are pale skin, sweating, trembling, and
pupillary dilation. Someone who has anxiety might also experience it as a sense of
dread or panic.
Shodhganga (2009) conducted a descriptive study on the effect of alcoholism
with the objective of making a comparison of the wives of alcoholics, on their
anxiety, adjustment, self-concept and assertiveness with regard to wives of non-
alcoholics. She compared and reported that wives of alcoholics have higher anxiety as
well as depression state than the wives of non-alcoholics.
A relaxation technique (also known as relaxation training) is any method,
process, procedure, or activity that helps a person to relax; to attain a state of
increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger.
Relaxation techniques are often employed as one element of a wider stress
management program and can decrease muscle tension, lower the blood pressure and
slow heart and breath rates, among other health benefits. Various techniques are used
by individuals to improve their state of relaxation. Some of the methods are
performed alone; some require the help of another person (often a trained
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professional); some involve movement, some focus on stillness; while other methods
involve different elements.
Certain relaxation techniques known as "formal and passive relaxation
exercises" are generally performed while sitting or lying quietly, with minimal
movement. These includes movement-based relaxation methods incorporate exercise
such as walking, gardening, yoga, Tai chi, Qigong, and more. Some forms of
bodywork are helpful in promoting a state of increased relaxation. Examples include
massage, acupuncture, Myotherapy, reflexology and self-regulation.
Some relaxation methods can also be used during other activities, for example,
auto suggestion and prayer. One study has suggested that listening to certain types of
music, particularly new age music and classical music, can increase feelings
associated with relaxation, such as peacefulness and a sense of ease.
Relaxation techniques have been considered as an adjunctive therapy for
anxiety and can provide patients with self-maintenance coping skills to reduce anxiety
symptoms. Such techniques, including hypnosis, meditation and progressive muscle
relaxation (PMR), have been shown to reduce anxiety, and to a lesser degree
depressive symptoms, in a variety of medical and psychiatric illnesses. PMR is one
systematic technique that can be used to achieve a deep state of relaxation. It has
several advantages for patient.
Progressive muscle relaxation technique is a technique for reducing anxiety by
alternatively tensing and relaxing the muscles .It was developed by Edmund Jacobson
in the early 1920’s. Jacobson argued that since muscle tension accompanies anxiety,
one can reduce anxiety by learning how to relax the muscular tension. It entitles a
physical and mental component. Progressive muscle relaxation is a process that
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involves decreasing the physiological aspects of anxiety while distracting the
individual from their awareness of anxious feelings (Nassau, 2007).
Progressive muscle relaxation was originally developed as a way of reducing
anxiety by teaching individuals to relax their muscles. This leads to a reduction in
muscle tension and then a decrease in measures of physiological arousal associated
with muscle tension .This reduction can help to decrease anxiety and increase an
individual’s sense of well-being (Paterson, 1987).
The physical component involves the tensing and relaxing of muscle groups
over the legs, abdomen, chest, arms, and face. In this tension in a given muscle group
is purposefully done for approximately 10 seconds and then released for 20 seconds
before continuing with the next muscle group.
1.1 Need for the study
Alcoholism is harmful not only for the individual but also for his family and
the society at large. Particularly the wives of alcoholics are hurt and confused always.
She is the victim of addiction who do not use or drink alcohol, but is nevertheless
victimized by the problem. She is the victim struggling desperately to solve her
problems. So this study is an attempt to identify the level of anxiety faced by the
wives of alcohol dependents.
Alcohol consumption is linked to many harmful consequences for the
individual drinker, the drinker’s immediate environment and society as a whole. Such
social consequences are traffic accidents, workplace-related problems, family and
domestic problems, and interpersonal violence have been receiving more public or
research attention in recent years, indicating a growing interest in a broader concept of
alcohol-related consequences.
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Klingemann & Gmel (2001) note that a number of studies have demonstrated
an association between alcohol abuse and unemployment. Here, a causal association
may go in either direction, heavy drinking may lead to unemployment, as suggested
by Mustonen, but loss of work may also result in increased drinking, which may
become heavy drinking, as indicated by Gallant .With regards to trauma, alcohol is
the cause of 10% to 20% of work accidents in France.
Webb et al., 1994 conducted a survey in Australia of 833 employees at an
industrial worksite found that problem drinkers were 2.7 times more likely to have
injury related absences than non-problem drinkers.
Drinking can impair performance as a parent, as a spouse or partner, and as a
contributor to household functioning. There are also other aspects of drinking which
may impair functioning as a family member. Drinking also costs money and can
impact upon resources particularly of a poor family, leaving other family members
destitute. Also, it is worth noting that specific intoxicated events can also have lasting
consequences, through home accidents and family violence
Implicit in the habitual drinker's potential impact on family life is the fact that
the drinking and its consequences can result in substantial mental health problems of
family members.
Al-Anon, a companion organization to Alcoholic Anonymous for spouses and
family members of people with alcohol dependence. In interviews with 45 Al-Anon
members in Mexico (82% of them the wife of a husband who was alcohol-dependent),
73% reported feelings of anxiety, fear, and depression; 62% reported physical or
verbal aggression by the spouse toward the family; and 31% reported family
disintegration with serious problems involving money and the children .
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The effects of men's drinking on other members of the family is often
particularly on women in their roles as mothers or wives of drinkers. Apart from that
the risks include violence, HIV infection, and an increased burden in their role of
economic providers.
The economic consequences of expenditures on alcohol are significant
especially in high poverty areas. Besides money spent on alcohol, a heavy drinker
also suffers other adverse economic effects. These include lowered wages (because of
missed work and decreased efficiency on the job), lost employment opportunities,
increased medical expenses for illness and accidents, legal cost of drink-related
offences, and decreased eligibility of loans.
Baklien & Samarasinghe, 2001 conducted in 11 districts in Sri Lanka
examining the link between alcohol and poverty found that 7% of men said that their
alcohol expenditure was greater than their income. Though a relatively small
percentage, this is still a worrying statistic for the families concerned and for those
interested in helping the worst-off families.
Alcoholism has negative effects on the spouse of an alcoholic. The spouse
may have feelings of hatred, self-pity, avoidance of social contacts, suffer with
exhaustion and become physically or mentally ill (Berger 1993). A survey “Exposure
to Alcoholism in the family”, conducted in 1988 suggested that alcoholism is a major
factor of premature widowhood. Alcoholism also is one of the major reasons for
divorce.
Spouse of alcoholic clients have their identity in the society as wives of
alcoholics .They have to endure years of isolation ,blame of relatives ,lack of friends
little money, violence & unsatisfactory sexual relations .The spouse of drinkers suffer
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from elevated rates of depression, anxiety and somatic complaints, report level of
relationship satisfaction and often are subjected to verbal and physical abuse.
According to Raitasalo and Holmila, the links between the drinkers own
concerns and the pressure exerted by the spouse can be particularly troublesome when
he individual’s own evaluation is not supported by the partner. Notably, this is the
case when a person thinks that his drinking is not a problem, but the partner thinks
differently and tries to manage his behavior directly in various way; all these are
directly related with the spouse’s own feeling of strain.
This study will help community health nurses, and psychiatric nurses to
identify, various coping strategies adopted by wives of alcoholics and will help them
to strengthen the healthy adaptive coping strategies and rectify the maladaptive
coping strategies and help to perceive the stressful situations as manageable and
challenging
1.2 Statement of the problem
“A Study to evaluate the effectiveness of progressive muscle relaxation
technique on anxiety among spouse of alcoholic dependents at deaddiction centre,
GRH, Madurai.
1.3 Objectives of the study
To assess the level of anxiety among spouse of alcoholic dependents at
deaddiction centre, GRH, Madurai.
To evaluate the effectiveness of progressive muscle relaxation technique on
anxiety among spouse of alcoholic dependents at deaddiction centre, GRH,
Madurai.
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To associate the level of anxiety among spouse of alcoholic dependents at
deaddiction centre, GRH, Madurai and their selected socio demographic
variables.
1.4 Hypotheses
H1 – There is a significant difference between the pretest and posttest level of anxiety
among spouse of alcoholic dependents at deaddiction centre, GRH, Madurai.
H2 -There is significant association between the level of anxiety among spouse of
alcoholic dependents at deaddiction centre, GRH, Madurai and their selected
socio demographic variables.
1.5 Operational definition
Evaluation:
In this study it refers to judge or determine the significance, worth or quality
of progressive muscle relaxation technique on anxiety among spouse of alcoholic
dependents.
Effectiveness:
In this study it refers to the extent of reducing anxiety measured by Hamilton
anxiety scale.
Progressive muscle relaxation technique:
Progressive muscle relaxation technique is the systematic technique that can
be used to achieve a deep state of relaxation.
In this study it refers to the series of commands given by the researcher, to
stiff one group of muscle starting from face, neck, shoulder, arm muscles, hand, upper
back, abdomen, low back, knees, calve muscles and muscles of feet, and asked to
relax, for 5 consecutive days daily in the morning and evening for 30 minutes.
12
Anxiety
In this study it refers to level of intense apprehension, uncertainty, and fear
resulting from the anticipation of a threatening event situation, often to a degree that
normal physical and psychological functioning disrupted was measured by Hamilton
anxiety scale .
Spouse of alcoholic dependents
In this study it refers to the partner of the person who are obsessed with
alcohol and cannot control how much they consume even if it is causing serious
problems at home, work ,and financially.
Deaddiction Centre
In this study it is refer to a ward where the alcohol addicts are admitted for
detoxification and provided counseling support for relapse management, occupational
modification and family support.
1.6 Assumptions
Spouse of alcoholic dependents may experiencing various level of anxiety.
1.7 Delimitation
• The setting of the study is limited to deaddiction centre, GRH, Madurai.
The sample size is limited to 40 subjects.
The period of data collection is limited to six weeks.
1.8 Projected outcome
Practice of Progressive muscle relaxation technique will reduce the level of
anxiety by tensing and relaxing the various group of muscles.
Review of
Literature
13
CHAPTER-II
REVIEW OF LITERATURE
This chapter explains in detail about the review of literature and conceptual
framework used for the study. A literature review is a body of text that aims to review
the critical points of current knowledge including substantive findings as well as
theoretical and methodological contributions to a particular topic. Literature reviews
are secondary sources, and as such, do not report any new or original experimental
work. Also, a literature review can be interpreted as a review of an abstract
accomplishment.
Literature review serves a number of important functions in research process.
It helps the researcher to generate ideas or to focus on a research approach,
methodology, meaning of tools and even type of statistical analysis that might be
productive in pursuing the research problem.
Review of literature in the study is organized under the following headings.
1. Literature related to spouse of alcoholic dependents and anxiety
2. Literature related to effectiveness of progressive muscle relaxation
technique on anxiety.
3. Literature related to effectiveness of progressive muscle relaxation
technique on anxiety among spouse of alcoholic dependents.
14
2.1 Literature related to anxiety among spouse of alcoholic dependents
AlokTyagi, Shubham Mehta (2013) conducted a cross sectional study to
identify the correlation between alcohol consumption in husbands and anxiety and
suicidal ideation, in their wives. Thirty patients who were wives of persons dependent
on alcohol were assessed using PHQ-9 for anxiety and MSSI for suicidal ideation. 30
subjects recruited in this study were the wives of alcohol dependent men admitted to
the de-addiction ward of a hospital in Jaipur, India. Prevalence of anxiety was 62%
and suicidal ideation was 44%. Data analysis was done using karlpearson coefficient
of correlation .The correlation co-efficient value r=0.783 and the P<0.05, Results
revealed that there is significant positive correlation between alcohol consumption in
husbands and anxiety symptoms and suicidal ideation in their wives.
Manikandan .k.Mary Antony. P (2012) conducted a study to investigate the
influence of anxiety and age difference at marriage on coping styles of spouse of
alcoholics. This study was carried out in the selected De-addition centres Kerala.
Descriptive research design was used. By applying purposive sampling data was
collected from 60 women whose husband’s were undergoing deaddiction treatment.
To measure the level of anxiety of the respondents, Triat Anxiety Inventory was
administered. The completed instruments were collected back and scored and
analysed with Two way ANOVA. In this study calculated F value is 2.964 is greater
than tabled value 2.045 (p<0.01).The study revealed that state anxiety as well as trait
anxiety significantly interact each other in all components of coping styles.
Michellacleary, GlenE. Hunt(2012) study was conducted to assess the
alcohol use, alcohol problems, and depressive and anxiety Symptomatology among
newly married couples in counseling Centre ,Thailand. Descriptive design and
purposive sampling technique was used. A sample of Couples (N = 634) were
15
assessed by using multilevel models to analyze the association between one spouse’s
alcohol involvement and alcohol problems, and the study concluded that Both
husbands and wives marital alcohol problems were associated with wives anxiety and
depressive symptoms. The predictive validity of the selected variables were 0.923
(95% CI: 0.944-0.892) for anxiety and 0.796 (95 % CI: 0.751-0.728) for depression.
Calculated F value (F=3.097) is greater than tabled value (F=2.564) (p<0.01) Neither
spouse’s alcohol consumption was associated with wives anxiety and depressive
symptoms.
John H.Crystal. (2012) conducted a descriptive study to assess the
psychological status of wives of alcoholics. A self -administered questionnaire was
administered to the 19-60 years old wives of 100 males referred to the outpatient
department of a psychiatric hospital because of a suspected drinking problem..,
Results indicate that high frequency of impaired psychological status (e.g. anxiety,
avoidance feeling , seeking outside help) is associated with a relatively poor
treatment outcome. The results depicted that 65% of the respondents experienced low
level of anxiety and 35% experienced high level of anxiety, 55% of respondents had
mild avoidance feeling and 45% had moderate form of avoidance feeling. 35% of
respondents were seeking outside help and 65% were not seeking outside help. The
correlation co-efficient value r=0.699 and the P<0.01.The components, which are
most uniformly associated with a poor prognosis, were those that suggested a
withdrawal or disengagement from the marital bond negatively correlated with
symptoms.
Robert Rosenheck (2009) conducted a study to assess the psychological
changes in wives of alcoholic. Descriptive design and purposive sampling technique
was used. Minnesota Multiphasic Personality Inventory (MMPI) and the California
16
psychological inventory (CPI) administered to 30 women whose husbands were
participants in an inpatient treatment program for alcoholism. Data from the MMPIs
completed by all 30 women and from California psychological inventory .Results
revealed that among the respondents 36.9% met the criteria for an anxiety disorder
and 33.5 % experienced the depression and the 39% answered for stress. Calculated F
value (F=2.004) is greater than tabled value (F=1.098) (p<0.05) indicated that wives
of alcoholics are having impaired psychological status such as anxiety, depression
stress .
Shodhganga.(2009) conducted a descriptive study to assess the level stress,
anxiety, coping behavior of the wives of alcoholic men who were admitted into a
therapeutic programme for giving up alcohol drinking, 46samples, aged (22-
43years)were administered a questionnaire designed by J.Orford and S.Guthrie for
measuring coping behavior of alcoholics as well as competitive state anxiety
Inventory. Demographic details were also collected. Education status, type of family
and residential status has been significantly associated with high anxiety score and
other socio-demographic variables i.e. Gender, Religion, family monthly income and
marital status were not associated with high anxiety score. The study findings was
calculated F value (F=4.456) is greater than tabled value (F=2.972)(p<0.01). It
revealed that more than one third of the respondents experienced high level of anxiety
and impaired coping behavior and marked level of stress
Nirmala.D, R.K.R.EstherAmudha (2008) conducted a study to identify the
demographic condition, economic status and anxiety faced by the wives of alcohol
dependents. This study was carried out at the De-addition center, Khajamalai Ladies
Association, Trichy. Descriptive research design was used. By applying simple
random sampling data was collected from 100 respondents. To measure the level of
17
anxiety of the respondents, Hamilton anxiety Anxiety scale was administered. The
results depicted that 65% of wives of alcoholics experienced low level of anxiety,
35% were experienced moderate level of anxiety. Data analysis was done using Karl
pearson co-efficient of correlation method. The correlation co-efficient value r=0.657
and the P<0.05, Hence there is a positive correlation between the economic condition
and level of anxiety experienced by the respondents. The study revealed that more
than one third of the respondents experienced high level of anxiety.
2.2 Literature related to effectiveness of progressive muscle relaxation technique
on anxiety.
Febu Elizabeth joy et al.(2014) conducted an exploratory study to identify
the adolescents with social anxiety and teach the JPMR technique to those who would
score high on social anxiety scale. The data were collected from 193 high school
adolescents in various schools of Kenya. Using Demographic Proforma, Social
Anxiety Scale for Adolescent and Tool to Assess the Associated Factors of Social
Anxiety. The JPMR technique was administered to the adolescents with moderate to
severe social anxiety for one session for 45 minutes for 10 days Descriptive statistics
was used , Categorical data was compared using Chi square test .paired ‘t’ test was
used to find out the significance difference between the mean pre-test and mean post
test scores. Relationship between social anxiety and associated factors of social
anxiety were analysed by Spearmann rank correlation. The findings stated that 104
(54%) experienced mild social anxiety, 52 (27%) was experienced moderate anxiety,5
(3%) experienced severe anxiety. The chi square computed to find out the association
between social anxiety and selected variables revealed that there was a significant
association between age and social anxiety.( 2= 15.297,df=3,p=0.001). The mean
difference between mean pre-test and post test scores (14.45) was significant at o.o5
18
level (t=10.646 df=39 p=0.001) indicating JPMR therapy was effective in reducing
social anxiety
Yunping Li et al.(2014) conducted a true experimental study to explore the
effects of progressive muscle relaxation (PMR) on anxiety, and quality of life (QOL)
in patients with pulmonary arterial hypertension (PAH) in chinwong medical college
&hospitals, china. One hundred and thirty Han Chinese patients with PAH were
randomly assigned to a PMR group and a control group. The control group and the
PMR group were comparable at baseline. The PMR group received one session per
day for 12 weeks of PMR training. Anxiety level was measured using the state-trait
anxiety inventory (STAI). Health-related QOL was measured with SF-36 instrument.
The patients were evaluated with STAI and SF-36 before and after the PMR
intervention. The control group and the PMR group were comparable at baseline.
After 12 weeks of intervention, both groups showed significant improvement in
overall QOL (P<0.05). The PMR group, but not the control group, showed significant
improvement in anxiety, after intervention (P<0.05). Moreover, the PMR group
showed significant improvement in all QOL domains after intervention; After 12
weeks of intervention, the PMR group showed significant improvement in anxiety,
and QOL, The findings of the study revealed that Mean pre-test score was 52.4 and
the mean post-test score was 38.14 at 0.05 level of significance hence statiscally the
PMR is effective for reducing anxiety.
Maryam zargardesh and Maryam Shirazi.(2013) conducted a quasi-
experimental study in three stages on 49 male and female nursing students of
Isfahan University of Medical sciences divided into two groups (study and control). In
the pre-test stage, demographic data and Sarason anxiety questionnaires were filled by
94 students (of terms 3 and 4). Then, in the intervention stage, the students having test
19
anxiety were assigned to two groups (study and control), and the progressive muscle
relaxation method was performed in the experiment group in two session per day for
10 days. Independent ‘t’ test and chi square test showed no significant difference in
demographic characteristics between study and control groups before intervention
(P=0.76). The results of Mann Whitney test also showed no significant difference in
anxiety scores before intervention (P=0.60), but this difference was significant after
intervention (p=0.001)The mean level of anxiety during pretest was 89.82 and during
post-test it was reduced to 69.55. There was an effectiveness of progressive muscle
relaxation technique was found. The results showed that performing progressive
muscle relaxation method was effective in reducing test anxiety among nursing
students. It is suggested to conduct educational programs concerning this method in
the faculties of nursing to decrease the test anxiety of nursing students.
VP SinghV. RaoPrem V. Sahoo RC (2012) conducted a randomized
controlled study of pre-test post-test design, to evaluate the acute effects of music
and progressive muscle relaxation (PMR) in hospitalized COPD subjects after a
recent episode of exacerbation. In this study 82 COPD subjects were recruited from
K.M.C hospitals. After being screened 72 subjects were selected for the study. Results
revealed that there was statistically significant in main effect across the sessions for
state anxiety (F = 6.024, p = 0.003), trait anxiety (F = 8.222, p = 0.000), dyspnea (F =
10.659, p = 0.000), SBP (F = 12.889, p = 0.000), PR (F = 4.746, p = 0.008) and RR
(F= 12.078, p = 0.000). Music and PMR are effective in reducing anxiety and
dyspnoea along with physiologic measures such as SBP, PR and RR in two sessions
in COPD patients hospitalized with exacerbation.
Hairul Anuar Hashim et al. (2012) conducted a study to compare the effects
of two different techniques, namely progressive muscle relaxation (PMR) and internal
20
imagery on state anxiety among taekwondo players in Malaysia and Iran. The method
was designed by eighty eight taekwondo players (Mean age: 12.79) were randomly
assigned into 4 groups.The subjects were given by 24 sessions of PMR and internal
imagery for 8 weeks. State Trait Anxiety inventory (STAI) was used .Two statistical
analysis were used .Descriptive statistics were used for data screening ad two way
repeated measurements ANCOVA was used to examine between group differences.
Data were analysed using SPSS. The findings of the study mean level of anxiety
during pretest was 89.82 and during post-test it was reduced to 69.55 for progressive
muscle relaxation, for the internal imagery mean level of anxiety during pretest was
56.47 and during post-test it was reduced to 50.55 .Hence, it is concluded that these
two techniques have effects on reduce somatic and cognitive anxiety and increase self
confidence in Malaysian and Iranian -taekwondo players.
Nilhan Sezgin & Bahar Ozcan (2010) conducted a randomized controlled
study to investigate the effect of Emotional Freedom Techniques (EFT) and
Progressive Muscular Relaxation (PMR) on test anxiety. A group of 312 high school
students enrolled at a private academy were evaluated using the Test Anxiety
Inventory (TAI), Scores for 70 students demonstrated high levels of test anxiety; these
students were randomized into control and experimental groups. After 2 months,
subjects were retested using the TAI. A statistically significant decrease occurred in
the test anxiety scores of both the experimental and control groups. The EFT group
had a significantly greater decrease than the PMR group (p < .05). The scores of the
EFT group were lower on the Emotionality and Worry subscales (p < .05). Both
groups scored higher on the test examinations after treatment. The result for EFT is (F
= 6.024, p = 0.003), and for the PMR group is (F = 5.222p = 0.000) Although the
improvement was greater for the EFT group, the difference was not statistically
21
significant. The emotional freedom techniques group had a significantly greater
decrease than the PMR group.
B.Navaneethan & R. Sundararajan. (2009). Conducted a study to determine
the effectiveness of the muscle relaxation program in reducing anxiety and action
strategy and prepare to relax muscular progressive among volley ball players. The
researcher used the experimental method, and the study consisted of 24 male volley
ball players from PSG College of Arts and science, Coimbatore. Competitive State
Anxiety Inventory -2 (CSAI-2, Martens et al.1990) was used . Experimental group
was given with progressive muscle relaxation for 3 days a week for 6 week. Paired ‘t’
test were Used to test the effect of treatment groups individually between pre-test and
post-test of all groups on variables used in the study. The result of the study shows
that PMRT had an impact in reducing anxiety among experimental group (t=9.53)
with mean difference 1.42 as compared to control group (t=1.45) with mean
difference of 0.30.The results of the study are, statistically significant differences
between the control and experimental groups in the post-test; this means that the
reduction in degree of anxiety competition at the end of the Training .
Heidi A Larson (2009) Conducted an experimental study on effect of
progressive muscle relaxation on anxiety among chronically ill patients in a selected
hospital Mangalore. An evaluative approach with one group pre-test post-test design
was adopted. 73 chronically ill patients with diabetes mellitus, hypertension, and low
back pain were purposively selected for administering Zung self-rating anxiety scale
for identifying the level of anxiety. Out of the 52 patients scored above 44, 35
subjects were selected. Progressive muscle relaxation was given for 15-20 minutes
daily to each subject for 2 weeks. Descriptive statistics was used, Categorical data
was compared using Chi square test .paired ‘t’ test was used to find out the
22
significance difference between the mean pre-test and mean post test scores. The
findings showed that Mean pre-test score was 22.08 with mean difference 1.58 and
the mean post-test score was 20.50 with mean difference 1.58 (t=10.65). There was a
significant difference between pre and post test scores .It indicates the impact of
progressive muscle relaxation in reduction of anxiety score.
Dellora et al. (2009) conducted a study to determine the effectiveness of
progressive muscle relaxation technique on anxiety among elderly people. Data was
obtained from the 40 elderly persons staying in Sarvodaya old age home in Gujarat.
Through the standard State Trait Anxiety Inventory Scale the level of anxiety was
assessed. Purposive sampling technique was used. The research design of the study
was quasi experimental design. The progressive muscle relaxation was given for
subjects for two sessions per day for one week. Independent ‘t’ test was used for
statistical analysis. The results depicted that 45% of the respondents experienced low
level of anxiety and 35% experienced moderate level of anxiety, 20% experienced
high level of anxiety. The mean level of anxiety during pretest was 89.82 and during
post-test it was reduced to 69.55. Hence there is a significant difference in the mean
scores of anxiety. It indicates the effectiveness of progressive muscle relaxation
technique in reducing anxiety.
Thomas S.Parish (2008) conducted an experimental study on effect of
progressive muscle relaxation therapy in reducing stress and anxiety of cancer
patients in Vellore. A total of 60 patients were randomly assigned to treatment and
control groups. The experimental group was given by PMR once a day for 4 weeks.
Global assessment of recent stress for stress assessment and Taylor’s anxiety scale for
anxiety assessment were used. Descriptive statistics was used, Categorical data was
compared using Chi square test. Paired ‘t’ test was used to find out the significance
23
difference between the mean pre-test and mean post test scores. The results revealed
that pre-test level of anxiety was 22.75, post-test level of anxiety was 21.25 with SD
0.151,(t=9.95) for experimental group. For control group, the pre-test level of anxiety
was 21.75, post-test level of anxiety was 21.50 with SD 0.910 (t=1.22) mean score of
anxiety among experimental group was 1.17 and that of control group was 3.9. The
study stated that there is a significant relationship between anxiety and progressive
muscle relaxation at 0.05 level of significance .
Cheyung YL et al.(2003) conducted a randomized controlled study with 59
colo rectal cancer patients after stoma surgery. Control group receive routine care and
experimental group receive routine care and PMRT through two teaching sessions and
practice at home for the first 10 weeks. Two statistical analysis were used
.Descriptive statistics were used for data screening and two way repeated
measurements ANOVA was used to examine between group differences. The mean
score of anxiety among experimental group was 3.098 and that of control group was
5.239 at 0.005 level of significance . The use of PMRT significantly decrease the state
anxiety and improved generic quality of life in the experimental groups (P‹0.05).This
study recommended that the use of PMRT should be incorporated in the long term
care of colo rectal cancer patients ,as it can improve their psychological health and
quality of life.
Chenwc (1996) conducted an experimental randomized controlled trial study
using repeated measures. Study participants were acute psychiatric inpatients in
Taiwan. Eighteen patients were block randomized and then assigned to an
experimental ands control group. The experimental group received progressive
muscle relaxation training and the control group received a placebo intervention.
Results from the Beck anxiety inventory were compared between groups as a pretest.
24
In pretest, clients are having 18.27 mean score and in posttest they are having 10.73
score. Difference is 7.54 .This difference is statistically significant. The degree of
anxiety improvement was significantly higher in the progressive muscle relaxation
training group than in the control group after progressive muscle relaxation training
intervention
2.3 Literature related to effectiveness of progressive muscle relaxation technique
on anxiety among spouse of alcoholic dependents.
Kaur Ramanpreet (2014) conducted a quasi-experimental study on 60
spouse of alcoholic clients to assess the effectiveness of progressive muscle relation
therapy in reducing anxiety in selected various alcoholic rehabilitation centre of
Ludhiana, Punjab. 50 spouse of alcoholic clients in experimental group was given by
progressive muscle relaxation for one week twice a day. The result of the study shows
that PMRT had an impact in reducing anxiety among experimental group (t = 16.32)
as compared to control group (t = 0.47) (p<0.05).The level of anxiety reduces in
experimental group after PMRT, therefore guidelines were given to the control group
for PMRT to reduce their anxiety level.
Sikandernayak et.al (2014) conducted a quasi-experimental study, with pre
and post-test without control group design was undertaken on 100 female spouse of
alcoholic patients in de-addiction centre of Cuttack, Odisha, to assess the
effectiveness of progressive muscle relaxation technique to relieve anxiety among
spouse of alcoholic patients. The samples were selected by purposive sampling
technique. Data were collected from 24.06.2014 to 07.07.2014 through Hamilton
anxiety scale. PMRT was given for twice a day for 5 days. The data collected were
analyzed by using descriptive and inferential statistics. Findings revealed that in pre-
test the highest (67%) of the spouse of alcoholic patient had panic level of anxiety
25
related to physical factor and highest 45% of them had severe level of anxiety in
economical factor. The mean level of anxiety during pretest was 56.52 and during
post test it was reduced to 48.45. Hence there is a significant difference in the mean
scores of anxiety, the author concluded that progressive muscle relaxation was very
effective for anxiety among spouse of alcoholic patients
Liping Zhao, Haishan Wu, Xihong Zhou (2012) conducted a controlled,
randomized, open-label study. One hundred consecutive Chinese spouse of alcoholic
clients, aged 18-48 years, were randomly assigned to a PMR group (n=50) and a
control group (n=50). After 12 weeks of intervention, both groups showed significant
improvement. Mean value of experimental group is 0.15 and standard deviation is
0.40,and control group mean value is 0.06 ,standard deviation is 0.26.The PMR
group, but not the control group, showed significant improvement in state anxiety,
trait anxiety and depression after intervention
Francis, Neethu; D'silva, Fatima 2012 conducted a randomized control
study to test the effectiveness of Jacobson's Progressive Muscle Relaxation Technique
on anxiety among 60 spouse of alcoholic clients in selected de-addiction center
,Mangalore. The experimental group was subjected to the intervention (PMR) for 30
minutes daily for a period of 5 days. Both the groups (Experimental and Control)
were observed with pretest and post-test. The mean pre-test score of anxiety in the
experimental (30) and control group (30) were 16.667 and 16.70 respectively.
Psychological factors (74.137%) affected anxiety more than the environmental factors
(65.989%). Repeated measures ANOVA revealed a significant difference in the
anxiety from Day 1 to Day 5 (F Cal=378.38 > F tab (1, 4) = 7.71, p<0.005). The
Bonferri multiple comparison test revealed a significant improvement in the anxiety
from day 2 onwards. The calculated t-value of anxiety was 17.892, was more than the
26
table value t tab (58) = 2.00, p<0.05. Hence, the study revealed a significant
improvement in the anxiety in the experimental group after PMR. revealed that 5 days
of progressive muscle relaxation therapy was very effective for spouse of alcoholic
patients anxiety. Thus nurses have to be trained in providing cost effective, non
pharmacological therapies like PMR to enhance the comfort of the client.
Pragya Pathak et al (2012) conducted quasi experimental study using pre-
test post-test control group design. Total of 100 participants, 50 in each intervention
and control group were included from selected de-addiction centre in Canada. PMR
was given for 5 days 30 minutes for each session, twice a day. Hamilton Anxiety
scale was used . The mean anxiety score is 10.6 was more than mean post test score
5.4 after receiving progressive muscle relaxation technique, the ‘t’ value is 7.14. The
results revealed that there was significant decrease in Pre to Post-assessment mean
anxiety scores (p<0.05) of study participants in intervention group .Progressive
muscle relaxation was found effective to significantly reduce anxiety in spouse of
alcoholics. This study, reveal the implication and importance of PMR to reduce
anxiety among spouse of alcoholic clients. Hence , it was proved that PMR is
effective in reducing anxiety.
Choi (2010) , conducted a comparative study to examine the effectiveness of
music and progressive muscle relaxation (PMR) on anxiety, and fatigue, in spouse of
alcoholic patients. The study involved 32 Chinese spouses who had been caregiving
in alcoholic for more than two weeks in alcoholic rehabilitation centre. Participants
received one of four conditions (silence, just music, just PMR, and music with PMR)
for 30 minutes, twice weekly, for two weeks. The researcher conducted pre- and post-
tests for anxiety and fatigue before and after each individual session .There were
significant decrease in anxiety (F=28.45,P<0.001)and fatigue (F= 26.27,P<0.001).The
27
research showed a significant decrease in anxiety and fatigue across all four
conditions after two weeks.
Fengliyu (2009) conducted an experimental study in Japan on application of
relaxation in spouse of alcoholic clients, by comparing the three groups: relaxation
group (progressive muscle relaxation and modified autogenic training); ordinary
supportive psychotherapy group, and finally no psychiatric treatment group. The
findings was F=6.68,P=0.002 for experimental group, and the control group findings
was F=4.58,P=0.012. There were no significant differences in the scores (except for
anger) among the three groups .The two results suggest that a combination of
progressive muscle relaxation and modified autogenic training is a useful method,
which can be easily employed in spouse of alcoholic clients.
SermsakLolak et al.(2008) conducted a prospective, randomized controlled
study to examine the effect of progressive muscle relaxation (PMR) training on
anxiety and depression in spouse of alcoholics in various alcoholic rehabilitation
centre in Taiwan. The standard program included 2 days per week of exercise,
education and psychosocial support delivered by a multidisciplinary team. The
intervention group received additional sessions of PMR training using a prerecorded
tape for 25 min/week during weeks 2-8.For anxiety, there was an overall significant
improvement within each group over time mean =9.46, standard deviation =7.84 (p <
0.0001). In statistical significance, the results favored the PMR group for weeks 5-8.
Depression scores were lower for the PMR throughout weeks 1-8.The author
concluded that PMR is effective in reducing anxiety and depressive level in spouse of
alcoholic clients.
28
2.4 Conceptual framework
Denise F.Polit, and Cheryl models, like theories, provide context for nursing
studies. Framework is conceptual underpinning of a study. In many studies, the
framework is implicit, but ideally researches clarify the conceptual definitions of key
concepts. Several conceptual models of nursing have been developed and have been
used in nursing research. The concept central to models of nursing are person,
environment, health, and nursing. Schematic models are representations of
phenomena using symbols or diagrams. Statistical models use mathematic symbols to
express quantitatively the nature and strength of relationships among variables.
In this study researcher utilized a framework based on the Modified Sister
Callista Roy’s Adaptation Model. As per the Roy’s view, person is a bio psycho
social being in constant interaction with the changing environment. Human beings are
tried to sustain balance between the bio psycho social factors and the outside
environment. The adaptation level is constantly changing point, made up three stimuli
said to be focal, contextual and residual stimuli. Here the focal stimuli of the person
are constant interaction with changing environment. The person cope with changing
world, the individual used both innate and external stimuli and thereby obtain coping
mechanism from the environment. The researchers considers progressive muscle
relaxation technique as a focal stimuli to the anxiety of spouse of alcoholic.
The human beings adaptive level such ass that it comprised a zone indicating
the range of stimulation that lead to a positive responses that the integrity of the self
in return of goal of adaptation and survival of growth and mastery. It has four models
namely physiological mode. Self-concept mode, role performance mode and
interdependence mode.
29
Input
Through the process of selecting the model regulates the types and the amount
of input received, some types of inputs are used immediately in their original state.
Input refers to the actual planning of action to send the information to open system.
Input refers target group with their characteristics level of competencies and interest.
Socio demographic variables would have some influences on anxiety among spouse
alcoholic dependents, such as age, religion, education, occupation, total income of the
family, type of family, residential status, number of children, duration of consumption
of alcohol of their husband, any physical illness, previous relaxation experience.
pretest to assess their level anxiety, and the intervention is progressive muscle
relaxation technique which was given for 30 min twice a day for 5 consecutive days.
Process
Physiological mode- the basic action of this mode is enhance the
physiological integrity and is composed of the needs associated with oxygenation,
circulation, nutrition, elimination, activity and rest and protection. The complex of
this mode are associated with the senses, fluids and electrolytes, neurological function
and endocrine functions. Progressive muscle relaxation technique enhances the
physiological integrity and thus it results in increase sleep, maintain neurological
functioning, feels active and energetic.
Self-concept mode this mode relates to the basic need for psychic integrity.
Its focuses is on the physiological and spiritual aspects of the person. Progressive
muscle relaxation technique enhance the body sensation and makes an individual to
feel self-consistency, self-idea and ethical-moral-spiritual self. Self-consistency
represents the person efforts self-organization and to avoid disequilibrium. Self-ideal
30
represents what the person expects to be and do, and moral-ethical-spiritual self
represents the persons belief system and self-evaluation.
Role function mode this mode identifies the patterns of social interaction of
the person in relation to others reflected by the primary, secondary and tertiary rules.
Behaviors in this mode are said to be instrumental or expressive behavior.
Progressive muscle relaxation technique enhance the instrumental behaviors and thus
results in long term orientation mastery over the feelings, able to ventilate or express
emotions in proper manner. Enhance attitudes and enhance social integrity such as
increase group performance, increase independency and increase social activity.
Interdependent mode in this interdependent mode, the affectional needs are
met. Progressive muscle relaxation technique helps to reflect the strong humanistic
values such as love, affection, human values, and affirmation and maintain good
interpersonal relationship.
The researches believes that the overall action of these four modes, said to be the
output of the study, will reduce anxiety, increase interpersonal relationship increase
energy level, promotes self-esteem, increase emotional well being and improve
quality of life among the spouse of alcoholic dependents
Output
Output is the end result of nursing interventions. Output can be adaptation to the
stimuli or mal adaptation to the stimuli. In this study, adaptation leading to reduction
of anxiety or mal adaptation leading to no changes in the level of anxiety among the
spouse of alcoholic dependents.
31
Soci
o de
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31
32
CHAPTER-III
RESEARCH METHODOLOGY
The methodology of research indicates the general pattern of organizing the
procedure for assembling valid and reliable data for investigation. This chapter
provides a brief explanation of the method adopted by the investigator in this study. It
includes the research approach, research design, and variables, setting of the study,
population, sample and sample size, sampling technique, description of the tool, pilot
study, data collection procedure and plan for data analysis.
The present study aimed to evaluate the effectiveness of Progressive muscle
relaxation technique on anxiety among spouse of alcoholic dependents at deaddiction
centre, Government Rajaji Hospital ,Madurai.
3.1 Research approach
A quantitative evaluative research approach was used in this study.
3.2 Research design
The research design used for this study is Pre- experimental one group pretest
posttest design.
Pretest Intervention Post test
O1 X O2
O1- Pretest level of anxiety among spouse of alcoholic dependents
X- Intervention of progressive muscle relaxation technique,30 minutes daily in the
morning and evening for 5 consecutive days.
O2- Post test level of anxiety among spouse of alcoholic dependents .
3.3 Research variables
Variables of the study included;
Research
Methodology
33
Independent variable: Progressive muscle relaxation technique
Dependent variable: level of anxiety
3.4 Settings of the study
The study was conducted at the deaddiction centre, Government Rajaji
Hospital Madurai. It is the second biggest Government Medical college Hospital in
Tamilnadu. It has all speciality departments .This is one of the main psychiatric
institution serving the people of south Tamilnadu. The Hospital is equipped with bed
strength of 2543 beds. Psychiatric ward is equipped with bed strength of 50 beds with
an annual census of 5800 patients and deaddiction ward with 10 beds and annual
census of 744-816 patients.
3.5 Population
Target population
The study population comprises of spouse of alcoholic dependents.
Accessible population
The accessible population comprises of spouses of alcoholic dependents at
deaddiction centre, GRH, Madurai.
Sample
The sample consist of the spouse of alcoholic dependents at deaddiction
centre, GRH, Madurai and those who fulfill inclusion criteria
3.7 Sample size
The sample size was 40 spouse of alcoholic dependents.
3.8 Sampling technique
Sampling Technique used in the study was non probability sampling
(consecutive sampling) technique.
34
3.9 Criteria for sample selection
Inclusion criteria
Spouse of alcoholic dependents who were staying in deaddiction centre,
Government Rajaji Hospital, Madurai.
spouse of alcoholic dependents with mild and moderate anxiety
spouse of alcoholic dependents those who were understand Tamil.
Exclusion criteria
who were not willing to participate in the study.
who were having musculoskeletal disorder.
who had severe anxiety
who were not available during data collection.
3.10 Research tool and technique
The technique used in this study was self report method.
Description of tool
The tool consisted of two sections
Section A
It consisted of socio demographic variables such as age, religion, educational
status, occupation, monthly family income, type of family, residential, number of
children, duration of alcohol consumption, any major physical illness, previous
experience of practicing relaxation technique.
35
Section B
Consisted of Hamilton anxiety scale
It is a 14 items questionnaire with each answer scored on a scale ranging from
0-5 which was designed to measure the level of anxiety.
3.11 Scoring
Scores were calculated by summing the scores of the given items. The scores
of each respondent over the scales are then evaluated as per the severity.
Less than 17 indicates mild anxiety
18-24 indicates moderate anxiety
25-30 indicates severe anxiety
31-56 indicates very severe anxiety
3.12 Validity of the tool
In order to measure the content validity, the questionnaire was given to 3
experts in the field of psychiatric nursing, psychiatrist and clinical psychologist and
statistician. They were requested to check the relevance, sequence and adequacy of
the items. The tool was first drafted in english and translated to tamil by an expert.
Language validity was established by retranslation of tool in to english.
3.13 Reliability of the tool
The reliability of an measuring instrument is a major criterion for assessing its
quality and adequacy. Reliability is the consistency with which it measures the target
attribute. The reliability of a tool was done by test retest method r = 0.93. Hence the
tool was reliable and was used in this study.
3.14 Pilot study
A pilot study was conducted at deaddiction centre, Government Rajaji
Hospital Madurai, to test the feasibility, relevance and practicability of the
36
intervention from 01.06.2015 to 07.06.2015 among 10 spouse of alcoholic
dependents. The findings of the study revealed that there was a significant reduction
in the level of anxiety among spouse of alcoholic dependents at Government Rajaji
Hospital Madurai. It revealed that the study was feasible and practicable.
3.15 Data collection procedure
Method of data collection
The data collection procedure was done at deaddiction ward, Government
Rajaji Hospital, Madurai. Prior to the data collection, Ethical clearance was obtained
from the Ethical Committee of Government Rajaji Hospital, Madurai, and from the
Professor and H.O.D Department of psychiatry to conduct the study. And written
permission obtained from the Principal, College of Nursing, Madurai Medical
College, Madurai. Verbal and written informed consent was obtained from all the
study participants. Data collection was done for six weeks from 01.08.2015 to
13.09.2015 at De-addiction ward, Government Rajaji Hospital, Madurai.
Self-introduction done and explained the nature of the study to spouse of
alcoholic dependents.
Pre-test was done on the first day by using Hamilton anxiety scale.
Session starts with 4 minutes of explanation and 4 minutes of breathing
relaxation exercises.
6 subjects in first week and 7, 8, 7, 6, 6, in forthcoming weeks respectively
upto 6 weeks.
Then the commands given by the researcher , to stiff one group of muscle
starting from face, neck, shoulder, arm muscles, hand, upper back, abdomen,
low back, knees, calve muscles and muscles of feet, (contracting 10 seconds
37
and holding 10 seconds) and asked to relax for 20 seconds .each group of
muscle repeated for 3 times.
Sessions were conducted daily morning (10.30-11.00am) and evening (3.00-
3.30 pm) two sessions per day for 30 minutes.
A period of 5 days was allowed for client to practice progressive muscle
relaxation technique
On the 6th day posttest was done
3.16 Plan for data analysis
The data analysis involved the translation of information collected during the
course of research project into an interpretable and managerial form. It involved the
use of statistical procedures to give an organization and meaning to the data. To
compute the data, a master sheet was prepared by the investigator. Descriptive and
inferential statistics used for data analysis.
Descriptive statistics
1. Analysis of socio demographic variables was done by using frequency and
percentage.
2. Anxiety among spouse of alcoholic dependents was analyzed by computing
frequency, percentage, mean and standard deviation.
Inferential statistics
1. Paired “t” test was used to examine pretest and posttest level of anxiety among
spouse of alcoholic dependents in deaddiction centre.
2. Chi-square analysis was used to find out the association between posttest level
anxiety among spouse of alcoholic dependents and selected socio
demographic variables
38
3.17. Protection of human rights
The research proposal was approved by the ethical committee experts prior to
the pilot study and permission was obtained from the Professor and H.O.D,
Department of Psychiatry. An informed verbal and written consent was obtained from
the each study subject before starting the data collection , and assurance was given to
the study subjects that confidentiality and privacy would be maintained throughout
the study. The subjects were informed that they can withdraw from the study at any
time.
39
DISSEMINATION OF RESULT
ANALYSIS AND INTERPRETATION
POST TEST ( Hamilton Anxiety Scale on day-6)
INTERVENTION (Progressive muscle relaxation technique ,30 mts twice a day for 5 consecutive days)
PRE TEST (Hamilton Anxiety Scale on day -1)
SAMPLING TECHNIQUE (consecutiveSampling )
SAMPLE SIZE (40 spouse of alcoholic dependents at deaddiction centre, at deaddiction centre,
GRH,Madurai )
SAMPLE(spouse of alcoholic dependents,Those who fullfilled the inclusion criteria)
ACCESSIBLE POPULATION (spouse of alcoholic dependents, at deaddiction centre, GRH,Madurai )
TARGET POPULATION (spouse of alcoholic dependents )
RESEARCH DESIGN (Pre experimental one group pretest post test Design)
RESEARCH APPROACH (Quantitative Approach )
Figure:2 Schematic Representation of Research Methodology
Data Analysis And
Interpretation
40
CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION
This chapter explains the statistical analysis performed on the collected data.
Analysis is the method for reading quantitative data meaningful and intelligible
information, so that the research problem can be studied and tested, including
relationships between the variables.
The data assembled, analysed, tested, for their significance. The findings based
on the statistical analysis are presented in this chapter. Descriptive statistics was used
for analyzing data in the light of objective of the study
The data collected were interpreted under the following sections
Section I
Distribution of spouse of alcoholic dependents according to their socio
demographic variables.
Section II
Description of level of anxiety among spouse alcoholic dependents.
Section III
Effectiveness of Progressive muscle relaxation technique on anxiety among
spouse of alcoholic dependents.
Section IV
Association between the level of anxiety among spouse of alcoholic
dependents and their selected socio demographic variables.
41
Section-I
Distribution of spouse of alcoholic dependents according to the socio
demographic variables.
Table-1: Frequency and Percentage Distribution of spouse of alcoholic
dependents according to their selected socio demographic variables
(n=40) Socio Demographic Variables f %
Age
21 - 35 yrs 23 57.5%
36 - 50 yrs 17 42.5%
Religion Hindu 32 80.0%
Christian 8 20.0%
Educational status
No formal Education 1 2.5%
Primary Education 11 27.5%
High School 20 50.0%
Higher Secondary 8 20.0%
Occupation Coolie 20 50.0%
Self-employment 13 32.5%
House wife 7 17.5%
Family monthly
income
Less than Rs.2000 29 72.5%
Rs.3001-Rs.5,000 11 27.5%
Type of family Joint family 23 57.5%
Nuclear family 17 42.5%
Residential status Rural 30 75.0%
Urban 10 25.0
42
No of children
Two children 24 60.0%
more than two children 16 40.0%
Duration of alcohol
consumption
1 to 5 years 18 45.0%
more than 5 years 22 55.0%
Any physical illness Yes 7 17.5%
No 33 82.5%
Previous relaxation
experience
Yes 6 15.0%
No 34 85.0%
Table 1 reveals that majority of spouse of alcoholic dependents 23 (57.5%)
were in the age group of 21 -35 years,17 (42.5%) were in the age of 36-50 years.
Most of the subjects 32 (80%) were belonged Hindu religion ,and 8 (20%)
were belonged Christian .
Regarding educational status, majority of the subjects, 20 (50%) have studied
up to high school education, 11 (27.5%) studied up to primary education and 8 (20%)
studied up to higher secondary, 1 (2.5%) of spouse of alcoholic dependents had no
formal education.
While discussing Occupation, majority 20 (50%) were working as coolie, 13
(32.5%) were self-employed, and 7 (17.5%) were House wife.
When comparing the family monthly income, majority of the subjects 29
(72.5%) were earning less than Rs.3000, and 11 (27.5%) were earning Rs.3000-5000.
Regarding type of family, majority of them 23 (57.5%) were living in the
nuclear family, and least 17 (42.5%) were living in joint family.
43
When comparing the nature of residential area, majority of spouse of alcoholic
dependents 30 (75%) were hailed from rural area, 10 (25%) were hailed from urban
area.
According to the number of children, majority of subjects, 24 (60%) were
having two children and 16 (40%) were having more than two children.
Regarding duration of consumption of alcohol, majority of subject’s husband
22 (55%) were consuming alcohol more than 5 years of period, 18 (45%) were
consuming alcohol 1 year to 5 years of period.
When comparing the physical illness, majority of the subjects 33 (82.5%) were
not having any physical illness and least 7 (75%) were having physical illness.
Regarding the previous experience of practicing relaxation techniques,
majority of subjects 34 (85%) were not practiced relaxation technique previously and
the least 6 (15%) were practiced previously.
44
Figure 3: Cylinder diagram portrays the distribution of spouse of alcoholic
dependents in deaddiction centre according to their age.
Majority of spouse of alcoholic dependents 23 (57.5%) were in the age of 21 -
35 years, 17 (42.5%) were in the age group of 36-50 years.
-10%
0%
10%
20%
30%
40%
50%
60%
70%
21 - 35 yrs 36 - 50 yrs
57.5%
42.5%
% o
f spo
use
AGE DISTRIBUTION
45
Figure 4: Pie diagram identifies the distribution of spouse of alcoholic dependents
in deaddiction centre according to religion.
Most of the subjects 32 (80%) were belonged Hindu religion ,and 8 (20%)
were belonged Christian.
Hindu 80.0% Christian
20.0%
RELIGION
46
Figure 5: Cylinder diagram states the distribution of spouse of alcoholic
dependents in deaddiction centre according to their educational status.
Majority of the subjects, 20 (50%) have studied up to high school education, 11
(27.5%) studied up to primary education and 8 (20%) studied up to higher secondary,
1 (2.5%) of spouse of alcoholic dependents had no formal education .
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
No formalEducation
Primary Education High School Higher Secondary
2.5%
27.5%
50.0%
20.0%
% o
f sp
ouse
EDUCATION STATUS
47
Figure 6: Simple bar diagram manifests the distribution of spouse of alcoholic
dependents in deaddiction centre according to their occupational status.
Majority 20 (50%) were working as coolie, 13 (32.5%) were self-employed,
and 7 (17.5%) were House wife.
0%10%20%30%40%50%60%70%80%90%
100%
Coolie Self employment House wife
50.0%
32.5%
17.5%
% o
f sp
ouse
OCCUPATION STATUS
48
Figure 7: Pie diagram depicts the distribution of spouse of alcoholic dependents
in deaddiction centre according to their family monthly income.
Majority of the subjects 29 (72.5%) were earning less than Rs.3000, and 11
(27.5%) were earning Rs.3000-5000.
Less than Rs.2000 72.5%
Rs.3001-Rs.5,000 27.5%
FAMILY MONTHLY INCOME
49
Figure 8: Cone diagram identifies the distribution of spouse of alcoholic
dependents in deaddiction centre according to their type of family.
Majority of them 23 (57.5%) were living in the nuclear family, and least 17
(42.5%) were living in joint family.
0%10%20%30%40%50%60%70%80%90%
100%
Joint family Nuclear family
57.5%
42.5%
% o
f sp
ouse
TYPE OF FAMILY
50
Figure 9: Cylinder diagram explains the distribution of spouse of alcoholic
dependents in deaddiction centre according to their residential status.
Majority of spouse of alcoholic dependents 30 (75%) were hailed from rural
area, 10 (25%) were hailed from urban area.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rural Urban
75.0%
25.0%
% o
f sp
ouse
RESIDENTIAL STATUS
51
Figure 10:Doughnut diagram portrays the distribution of spouse of alcoholic
dependents in deaddiction Centre according to their number of children.
Majority of subjects, 24 (60%) were having two children and 16 (40%) were
having more than two children.
Two children 60.0%
more than children 40.0%
NUMBER OF CHILDREN
52
Figure 11: Pie diagram showing the distribution of spouse of alcoholic dependents
in deaddiction centre according to duration of consumption of alcohol of their
husband.
Majority of subject’s husband 22 (55%) were consuming alcohol more than 5
years of period, 18 (45%) were consuming alcohol 1 year to 5 years of period
1 to 5 years 45.0%
more than 5 years 55.0%
DURATION OF ALCOHOL CONSUMPTION
53
Figure 12: Pyramid diagram narrates the distribution of spouse of alcoholic
dependents in deaddiction centre according to their physical illness.
Majority of the subjects 33(82.5%) were not having physical illness and least
7(75%) were having physical illness.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
17.5%
82.5%
% o
f sp
ouse
ANY PHYSICAL ILLNESS
54
Figure 13: Pie diagram identifies the distribution of spouse of alcoholic
dependents in deaddiction centre according to their previous experience of
relaxation techniques.
Majority of subjects 34 (85%) were not practiced relaxation technique
previously and the least 6 (15%) were practiced previously
Yes 15%
No 85%
PREVIOUS RELAXATION EXPERIENCE
55
Section II
Description of level of anxiety among spouse alcoholic dependents.
Table 2: Frequency and percentage distribution of spouse of alcoholic
dependents according to their level of anxiety
( n=40)
Level of anxiety Level of anxiety score
Pretest Posttest
Mild 12 30.0% 33 82.5%
Moderate 28 70.0% 7 17.5%
Severe 0 0.0% 0 0.0%
Very severe 0 0.0% 0 0.0%
Total 40 100.0% 40 100.0%
In the pretest, majority20 (70%) spouse of alcoholic dependents were in
moderate anxiety,12 (30%) were in mild anxiety .
In the posttest after receiving progressive muscle relaxation technique, 33
(82.5%) of spouse of alcoholic dependents were in mild anxiety,7 (17.5%) were in
moderate anxiety, and none of them were in severe /very severe anxiety score.
56
Figure 14: Cylinder diagram depicts the distribution of subjects according to
their level of anxiety among spouse of alcoholic dependents
In the pretest, 12(30%) were in mild anxiety, 20 (70%) were in moderate
anxiety, after receiving progressive muscle relaxation technique in the posttest 33
(82.5%) were in mild anxiety , 7 (17.5%) were in moderate anxiety, and none of them
were in severe /very severe anxiety score.
0%
20%
40%
60%
80%
100%
Pretest Posttest
30.0%
82.5%70.0%
17.5%
0.0% 0.0% 0.0% 0.0%
% o
f sp
ouse
PRETEST AND POSTTEST LEVEL OF ANXIETY
Mild
Moderate
57
Section III
Effectiveness of progressive muscle relaxation technique on anxiety among spouse
of alcoholic dependents.
Table 3: Mean and Standard Deviation of pretest and posttest level of anxiety
among spouse of alcoholic dependents
(n=40)
Anxiety
score MeanStandard
DeviationMean
difference “t”- value P- value
Pretest 18.27 3.56
7.54 t=8.35
TV=3.558
p=0.001***
Posttest 10.73 3.66
* significant at P 0.05 ** highly significant at P 0.01 *** very high significant at
P 0.001
The above table showed that the mean in the pretest and posttest was 18.27 and
10.73 and standard deviation in the pretest and posttest was 3.56 and 3.66 respectively.
The mean difference was 7.54. The paired “t” test value was 8.35 which were greater
than the table value (3.55),which was significant at 0.001.Hence it was evidenced that
progressive muscle relaxation technique was more effective in terms of reducing
anxiety among the spouse of alcoholic dependents.
58
Table 4: Comparison of pretest and posttest mean anxiety score among spouse of
alcoholic dependents
(n=40)
Anxiety score Mean ±SD Mean
difference Student’s paired t- test
Pretest 18.27±3.56 7.54 t=8.35p=0.001***
significant Posttest 10.73±3.66
* significant at P 0.05 ** highly significant at P 0.01 *** very high significant at
P 0.001
The above table 4 depicts comparison of mean anxiety score between pretest
and posttest .The pretest mean score was 18.27 with a standard deviation was 3.56
and the posttest mean score was 10.73 with the standard deviation was 3.66 .Mean
difference is 7.54. The student paired “t” test value was done to find out the difference
between pretest and posttest score , ‘t’ 8.35 was greater than the table value which was
significant at 0.001 level. This shows that the difference in the score was due to
intervention (progressive muscle relaxation technique) and also this proves that the
progressive muscle relaxation technique was effective in reducing the anxiety score
among spouse of alcoholic dependents whose husbands were admitted for deaddiction
therapy at deaddiction centre.
59
Comparison of pretest and posttest mean anxiety score among spouse of alcoholic
dependents
Figure 15: Box-plot diagram portrays the mean pretest and posttest score among
spouse of alcoholic dependents.
The pretest mean score was 18.27 with a standard deviation was 3.56 and the
posttest mean score was 10.73 with the standard deviation was 3.66 .Mean difference
is 7.54.
posttestpretest
Mea
n an
xiet
y sc
ore
30
20
10
0
60
Section-IV
Association between the level of anxiety among spouse of alcoholic dependents
and their selected socio-demographic variables.
Table 5: Association between level of anxiety among spouse of alcoholic dependents
and their selected socio demographic variables.
Socio Demographic Variables
level of anxiety reduction score Total
χ2Below average( 7.54)
Above average( 7.54)
f % f %Age 21 - 35 yrs 15 65.2% 8 34.8% 23 χ2=5.01
p=0.03 36 - 50 yrs 5 29.4% 12 70.6% 17
Religion Hindu 15 46.9% 17 53.1% 32 χ2=0.62p=0.42 Christian 5 62.5% 3 37.5% 8
Educational status
No formal Education 1 100.0% 0 0.0% 1
χ2=22.30p=0.001***
Primary Education 11 100.0% 0 0.0% 11
HighSchool 3 15.0% 17 85.0% 20
HigherSecondary 5 62.5% 3 37.5% 8
Occupation Coolie 10 50.0% 10 50.0% 20
χ2=1.97p=0.37
Selfemployment 5 38.4% 8 61.6% 13
House wife 5 71.4% 2 28.6% 7
Family monthly income
Less than Rs.2000 15 51.7% 14 48.3% 29 χ2=0.12
p=0.72 Rs.3001-Rs.5,000 5 45.5% 6 54.5% 11
Type of family
Joint family 9 39.1% 14 60.9% 23 χ2=2.55p=0.11 Nuclear
family 11 64.7% 6 35.3% 17
Residential status
Rural 16 53.3% 14 46.7% 30 χ2=0.53p=0.46 Urban 4 40.0% 6 60.0% 10
(n=40)
61
No of children
Twochildren 12 50.0% 12 50.0% 24 χ2=0.00
p=1.00 more than children 8 50.0% 8 50.0% 16
Duration of alcohol consumption
1 to 5 years 15 83.3% 3 16.7% 18 χ2=14.54
p=0.01 more than 5 years 5 22.7% 17 77.3% 22
Any physical illness
Yes3 42.9% 4 57.1% 7 χ2=0.17
p=0.63 No 17 51.5% 16 48.5% 33
Previous relaxation experience
Yes1 16.7% 5 83.3% 6 χ2=3.13
p=0.08 No 19 55.9% 15 44.1% 34
* Significant *** highly significant at 0.05 level
Table 5 explains the association between the posttest level of anxiety among
spouse of alcoholic dependents with their selected socio demographic variables. Chi-
square analysis revealed that there was an association between the posttest score and
age (36-50 years) education status (primary education, no formal education), duration
of alcohol consumption of their spouse (1-5 years period). All other variables were
not associated among the spouse of alcoholic dependents with their posttest score
62
Figure 16: Cone diagram showing the association between the level of anxiety
reduction score and age of the spouse of alcoholic dependents.
The above figure depicts an association between level of anxiety among spouse
of alcoholic dependents with their selected socio demographic variables, according to
the age of spouse of alcoholic dependents, the age group of 36-50 years were reduced
more anxiety than other age groups.
0%10%20%30%40%50%60%70%80%
21 - 35 yrs 36 - 50 yrs
65.2%
29.4% 34.8%
70.6%
% o
f spo
use
ASSOCIATION BETWEEN LEVEL OF ANXIETY REDUCTION SCORE AND AGE OF SPOUSE OF
ALCOHOLICS
Below average( 7.54)
Aboveaverage(>7.54)
63
Figure.17: Multiple cylinder diagram showing association between the level of
anxiety among spouse of alcoholic dependents and their educational status.
The above figure depicts an association between level of anxiety among spouse
of alcoholic dependents with their selected socio demographic variables, according to
the educational status ,who have primary education and no formal education spouses
were reduced more anxiety than others.
0%
20%
40%
60%
80%
100%
No formalEducation
PrimaryEducation
High School HigherSecondary
100.0% 100.0%
15.0%
62.5%
0.0% 0.0%
85.0%
37.5%
% o
f spo
use
ASSOCIATION BETWEEN LEVEL OF ANXIETY REDUCTION SCORE AND EDUCATION STATUS
Below average( 4.97)
Aboveaverage(> 4.97)
64
Figure 18: Pyramid diagram showing the association between the level of anxiety
reduction score and the duration of alcohol consumption of spouse of alcoholic
dependents.
The above figure depicts an association between level of anxiety among spouse
of alcoholic dependents with their selected socio demographic variables, according to
the duration of alcohol consumption ,who have 1-5 years period were reduced more
anxiety than others.
0%10%20%30%40%50%60%70%80%90%
100%
1 to 5 years more than 5 years
83.3%
22.7% 16.7%
77.3%
% o
f sp
ouse
ASSOCIATION BETWEEN LEVEL OF ANXIETY REDUCTION SCORE AND DURATION OF ALCOHOL CONSUMPTION OF SPOUSE
Below average( 7.54)
Aboveaverage(>7.54)
Discussion
65
CHAPTER – V
DISCUSSION
This chapter discussed about the result of the study interpreted from the
statistical analysis. Progressive muscle relaxation was originally developed as a way
of reducing anxiety by teaching individuals to relax their muscles. This leads to a
reduction in muscle tension and then a decrease in measures of physiological arousal
associated with muscle tension. This reduction can help to decrease anxiety and
increase an individual’s sense of well-being. Progressive muscle relaxation techniques
has been investigated for its potential benefit for individuals who experiences anxiety
and its related disorders. It is a very useful in relieving anxiety in various situation.
The effort of this study was to evaluate the effectiveness of progressive muscle
relaxation technique on anxiety among spouse of alcoholic dependents admitted at
deaddiction centre in GRH, Madurai.40 samples were selected by Non Probability
sampling (consecutive sampling) technique. The anxiety levels of subjects were
assessed with Standardized Hamilton Anxiety Scale.
5.1 Distribution of spouse of alcoholic dependents and their selected socio
demographic variables.
It is interesting to note that while mentioning about the age group of the
spouse of Alcoholic dependents, majority of subjects 23 (57.5%) of spouse of
alcoholic dependents were in the age group of 21 -35 years.
Regarding religion, most of the subjects 32 (80%) were belonged to Hindu
religion.
With respect of educational status, majority of the subjects, 20 (50%) have
studied up to high school education.
66
While mentioning Occupation, majority of the subjects 20 (50%) were
working as coolie.
Analysis of the family monthly income, majority of the subjects 29 (72.5%)
were earning less than Rs.3000.
It is interesting to note that while mentioning type of family among spouse of
alcoholic dependents, majority of them 23 (57.5%) were living in the nuclear family.
While stating the nature of residential area, majority of spouse of alcoholic
dependents 30 (75%) were hailed from rural area.
Regarding of the number of children, majority of subjects, 24 (60%) were
having two children .
When considering duration of alcohol consumption of their husbands, majority
of subject’s husband 22 (55%) were consuming alcohol more than 5 years of period.
When comparing the physical illness, majority of the subjects 33 (82.5%)
were not having physical illness.
Regarding the previous experience of practicing relaxation techniques,
majority of subjects 34 (85%) were not practiced relaxation techniques previously.
5.2 Discussion of the study based on its objectives:
The first objective of the study was to assess the level of anxiety among
spouse of alcoholic dependents at deaddiction Centre, GRH, Madurai.
Table 2 reveals that among the 40 spouse of alcoholic dependents in the pre-
test, majority20 (70%) were moderate anxiety,12 (30%) were in mild anxiety .In the
post-test after receiving progressive muscle relaxation technique,33 (82.5%) of
spouse of alcoholic dependents were in mild anxiety,7 (17.5%) were in moderate
anxiety, and none of them were in severe /very severe anxiety score.
67
The present study findings was supported by a study done by Alok Tyagi,
Shubham Mehta (2013) conducted a cross sectional study to identify the correlation
between alcohol consumption in husbands and anxiety and suicidal ideation, in their
wives. Thirty patients who were wives of persons dependent on alcohol were assessed
using PHQ-9 for anxiety and MSSI for suicidal ideation. The 30 subjects recruited in
this study were the wives of alcohol dependent admitted to the de-addiction ward of a
hospital in Jaipur, India. Prevalence of anxiety was 62% and suicidal ideation was
44%. Data analysis was done using karl pearson coefficient of correlation .The
correlation co-efficient value r=0.783 and the P<0.05, Results revealed that there is
significant positive correlation between alcohol consumption in husbands and anxiety
symptoms and suicidal ideation in their wives.
It was also supported by a study conducted at the De-addition center,
Khajamalai ladies association, Trichy on level of anxiety among spouse of alcoholic
dependents .Data was collected from 100 wives of alcoholic dependent individually
using, Hamilton anxiety scale. The correlation co-efficient value r=0.657 and the
P<0.05, Hence there is a positive correlation between the economic condition and
level of anxiety experienced by the respondents
The second objective of the study was to evaluate the effectiveness of
Progressive muscle relaxation technique on anxiety among spouse of alcoholic
dependents at deaddiction centre, GRH, Madurai.
The intervention Progressive muscle relaxation technique on anxiety created a
vast difference between the scores obtained by the spouse of alcoholic dependents
between the pretest and posttest.
Table 4 portrays the comparison of the level of anxiety among spouse of
alcoholic dependents. In order to find out the effect of progressive muscle relaxation
68
technique on anxiety among spouse of alcoholic dependents, a paired “t” test was
done between the pretest and posttest scores.
The mean pretest anxiety score was 18.27 with standard deviation of 3.56 and
the mean post-test anxiety score was 10.73 with standard deviation of 3.66. The mean
difference is 7.54. The obtained paired ‘t’ test value was 8.35 was significant at p
<0.001 level.
This revealed that there was a significant difference in the mean anxiety scores
between the pretest and posttest . Paired “t” test also showed a significant difference
between the pretest and posttest. This difference was due to the intervention,
progressive muscle relaxation technique. Hence the progressive muscle relaxation
technique was effective in reducing the anxiety levels among the spouse of alcoholic
dependents.
This findings of the study was consistent with a study done by
Kaur Ramanpreet which is a quasi-experimental study to assess the effectiveness of
progressive muscle relation therapy in reducing anxiety in selected various alcoholic
rehabilitation centre of Ludhiana, Punjab. 50 spouse of alcoholic clients in
experimental group was given by progressive muscle relaxation for one week twice a
day. The result of the study shows that Progressive muscle relaxation technique had
an impact in reducing anxiety among experimental group (t = 16.32) as compared to
control group (t = 0.47) (p<0.05).The level of anxiety reduces in experimental group
after Progressive muscle relaxation, and also concluded that Progressive muscle
relaxation technique may be useful for spouse of alcoholic dependents on anxiety.
It was also supported by Francis, Neethu; D'silva, Fatima’s Randomized
control study to test the effectiveness of Jacobson's Progressive Muscle Relaxation
Technique on anxiety among 60 spouse of alcoholic clients in selected de-addiction
69
center ,Mangalore. The experimental group was subjected to the intervention (PMR)
for 30 minutes daily for a period of 5 days. Both the groups (Experimental and
Control) were observed with pretest and post-test. The mean pre-test score of anxiety
in the experimental (30) and control group (30) were 16.667 and 16.70 respectively.
Psychological factors (74.137%) affected anxiety more than the environmental factors
(65.989%). Repeated measures ANOVA revealed a significant difference in the
anxiety from Day 1 to Day 5(. F Cal=378.38>F tab = 7.71, p<0.005). The calculated t-
value of anxiety was 17.892, was more than the table value t tab (58) = 2.00, p<0.05.
Hence, the study revealed a significant improvement in the anxiety in the
experimental group after Progressive muscle relaxation. This study results revealed
that 5 days of progressive muscle relaxation therapy was very effective for spouse of
alcoholic patients on anxiety.
Hence the stated Hypothesis - H1: “There is a significant difference
between the pretest and posttest level of anxiety among spouse of alcoholic
dependents at GRH, Madurai was accepted”.
The third objective of the study was to associate the level of anxiety
among spouse of alcoholic dependents at deaddiction centre, GRH, Madurai and
their selected socio demographic variables
In order to find out the association between the posttest scores of anxiety and
selected socio demographic variables, a Chi square analysis was done.
Table 5 reveals the association between the posttest anxiety scores and
selected socio demographic variables, among spouse of alcoholic dependents, there
was a significant association between the level of anxiety and selected socio
demographic variables such as age (χ2 = 5.01 P-0.03*), educational status (χ2 = 22.30
70
P-0.001***), duration of alcohol consumption (χ2 = 14.54 P-0.01* ) among spouse of
alcoholic dependents.
There was no significant association between the post-test level of anxiety and
the other socio demographic variables such as religion, occupation, family monthly
income, type of family, residential status, number of children, any physical illness,
previous relaxation experience.
The findings of the study was congruent with a study done by Fengliyu (2009)
conducted an experimental study in Japan on application of progressive muscle
relaxation in spouse of alcoholic clients who took treatment in de-addiction centre, by
giving progressive muscle relaxation training for 5 days .There is no intervention for
control group. 60 spouse of alcoholic dependents was used for this study Taylors
anxiety scale was used . Statistical analysis was done using descriptive and inferential
statistics. The findings was F=6.68,P=0.002 for experimental group, and the control
group findings was F=4.58,P=0.012. .There was a significant differences between
experimental and the control group values . Chi-square analysis revealed that there
was an association between the post test score and the spouse of alcoholics age
,education status , and type of family ,all other variables were not significantly
associated.
It was also supported by Sermsak Lolak et al’s prospective, randomized
controlled study to examine the effect of progressive muscle relaxation training on
anxiety and depression in spouse of alcoholics in various alcoholic rehabilitation
centre in Taiwan. The intervention group received progressive muscle relaxation
training two sessions per day using a pre-recorded tape for 5 days. The mean =9.46,
standard deviation =7.84 (p < 0.0001). In statistical significance, the results favored
the progressive muscle relaxation group. Anxiety scores in posttest were lower than
the pretest scores among intervention group , and also chi square analysis was done
71
to check the association. It reveals that there was an association between post test
score and educational status ,residential status ,family monthly income ,other socio
demographic variables had no association with post test scores.
Hence the stated hypothesis - H2: “There is a significant association
between the level of anxiety among spouse of alcoholic dependents at GRH,
Madurai and their selected socio demographic variables was accepted ”.
The results of present study imply that adding a complimentary therapy
(Progressive muscle relaxation technique) has contributed more benefits which in turn
reduced anxiety among the spouse of alcoholic dependents. Participants gained
knowledge and the ways to cope up with the anxious situations, when the need in
crisis and anxious conditions.
Summary,
Conclusion,
Implications &
Recommendations
72
CHAPTER – VI
SUMMARY, CONCLUSION, IMPLICATIONS AND
RECOMMENDATIONS
This chapter narrates the summary of the study and conclusion drawn. It also
clarifies the limitations of the study, the implications for different areas like nursing
education, nursing service administration, nursing practice, and nursing research. It
provides the recommendations made based on the study.
6.1 Summary of the study
The present study was undertaken to evaluate the effectiveness of Progressive
muscle relaxation technique on anxiety among spouse of alcoholic dependents at
deaddiction centre Government Rajaji Hospital, Madurai.
The objectives of the study were
To evaluate the effectiveness of progressive muscle relaxation technique on
level of anxiety among spouse of alcoholic dependents and to associate the s level of
anxiety and selected socio demographic variables.
The following hypothesis were tested at 0.05 level of significance.
H1 – There is a significant difference between the pretest and posttest level of anxiety
among spouse of alcoholic dependents at deaddiction Centre, GRH, Madurai.
H2 -There is significant association between the level of anxiety among spouse of
alcoholic dependents at deaddiction centre, GRH, Madurai and their selected
socio demographic variables.
A pre-experimental, one group pretest posttest design was used to evaluate the
effectiveness of progressive muscle relaxation technique on level of anxiety among
spouse of alcoholic dependents at GRH, Madurai.
73
A non-Probability sampling (consecutive sampling) technique was used to
select the sample by picks up all available subjects during the period of data
collection. The sample size was (40) spouse of alcoholic dependents at GRH,
Madurai.
The data collection tool consisted of two parts.
Part-I
It consisted of socio demographic variables such as age, religion, educational
status, occupation, monthly family income, type of family, residential status, number
of children, duration of alcohol consumption, any major physical illness, previous
experience of practicing relaxation technique.
Part-II
Consisted of Hamilton anxiety scale
It is a 14 item questionnaire and each answer scored on a scale ranging from
0-5 which was designed to measure the level of anxiety.
The tool was validated by experts in the field of Psychiatric Nursing,
Psychiatry, statistics, and Psychology. Data collection was done by using the
prescribed tool to assess the level of anxiety. Pretest was done on day 1 followed by
progressive muscle relaxation technique for the participants. Posttest was conducted
on 6thday using the same Hamilton anxiety scale.
Collected data was analyzed by using both descriptive statistics (Mean,
Standard Deviation, Frequency and Percentage) and inferential statistics (Paired ‘t’,
Chi-Square) and results were analysed.
6.2 Major findings of the study
Majority of subjects 23 (57.5%) of spouse of alcoholic dependents were in the
age group of 21 -35 years.
74
Regarding of religion, most of the subjects 32 (80%) were belonged to Hindu
religion.
With respect of educational status, majority of the subjects, 20 (50%) have
studied up to high school education.
While mentioning Occupation, majority of the subjects 20 (50%) were
working as coolie.
Analysis of the family monthly income, majority of the subjects 29 (72.5%)
were earning less than Rs.3000.
It is interesting to note that while mentioning type of family among spouse of
alcoholic dependents, majority of them 23 (57.5%) were living in the nuclear family.
While stating the nature of residential area, majority of spouse of alcoholic
dependents 30 (75%) were hailed from rural area.
Regarding the number of children, majority of subjects, 24 (60%) were
having two children.
When considering duration of alcohol consumption of their husbands,
majority of subject’s husband 22 (55%) were consuming alcohol more than 5 years of
period.
When comparing the physical illness, majority of the subjects 33 (82.5%)
were not having physical illness.
Regarding the previous experience of practicing relaxation techniques,
majority of subjects 34 (85%) were not practiced relaxation techniques previously.
Among 40 spouse of alcoholic dependents in the pretest, majority 28 (70%)
were moderate anxiety,12 (30%) were in mild anxiety ,whereas in the posttest after
receiving progressive muscle relaxation technique,33 (82.5%) of spouse of alcoholic
75
dependents were in mild anxiety, 7 (17.5%) were in moderate anxiety, and none of
them were in severe /very severe anxiety score.
The mean pretest anxiety score was 18.27 with standard deviation of 3.56 and
the mean posttest anxiety score was 10.73 with standard deviation of 3.66. The mean
difference is 7.54. The obtained paired ‘t’ test value was 8.35 was significant at
p <0.001 level.
There was a significant difference in the mean anxiety scores between the
pretest and post-test. Paired “t” test also showed a significant difference between the
pretest and posttest.
This proved clearly that the intervention progressive muscle relaxation
technique, was effective in reducing the anxiety levels among the spouse of alcoholic
dependents.
There was a significant association between the post test level of anxiety and
selected socio demographic variables such as age (χ2 = 5.01 P-0.03*), educational
status (χ2 = 22.30 P-0.001***), duration of alcohol consumption (χ2 = 14.54 P-0.01*).
No other variables had significant association with the anxiety level of spouse of
alcoholic dependents.
6.3 Conclusion
It is statistically evidenced that progressive muscle relaxation technique was
effective in reducing the level of anxiety among spouse of alcoholic dependents. It is
cost effective complimentary non - invasive therapy to reduce anxiety.
76
6.4 Implications for nursing
Nursing Practice
Progressive muscle relaxation technique need to be implemented as a part of
other therapies and is to be practiced by the nurses in the day today activities
while treating clients other than spouse of alcoholic dependents.
Nurses should motivate the spouse of alcoholic clients and other clients to
practice Progressive muscle relaxation technique in their daily life to
strengthen their coping mechanism.
Nursing personnel impart health education to the people in de-addiction centre
at community settings about the procedure and benefits of progressive muscle
relaxation technique which strengthens the community psychiatry.
Nursing Education
The nurse educators can focus on practical training regarding Progressive
muscle relaxation technique by the nursing students to cope up the new
environment and exam anxiety.
The nurse educator plan to conduct workshop regarding progressive muscle
relaxation technique for nursing faculties to manage the day today activities.
Nurse educator focus on community psychiatry regarding progressive muscle
relaxation technique by mass health education programme with the help of
nursing students.
Nursing Administration
Continuing nursing education and in service education can be planned by
nurse administrators which will aid in formulating protocols in impacting the
theory into practice.
77
Nurse administrator can impose the routine utilization of the anxiety
assessment scales in the psychiatric care settings.
Nurse administrators insist the nurses will spend time with spouse of alcoholic
dependents to talk through some of the more troubling aspects of psychosocial
adjustment.
Nursing Research
There is plenty of scope for research in the field of anxiety among spouse of
alcoholic dependents.
Research studies on anxiety among spouse of alcoholic dependents can help to
identify the existing knowledge gap in nursing practice and nursing education
and to fill in existing gaps.
This study can be baseline for further studies to build upon and motivate other
investigators to conduct further studies in spouse of alcoholic dependents.
This study also brings about the fact that more studies need to be done at
different settings, which are culturally acceptable, using various therapies.
6.5 Recommendations
A similar study with longer duration can be conducted to assess the long term
benefits of progressive muscle relaxation technique.
A similar study can be conducted by having a control group to observe the
value of other complementary therapy.
A comparative study can be conducted to evaluate the effectiveness of
progressive muscle relaxation technique with other various complementary
therapies among other population such as spouse of chronic illnesses.
78
A similar study can be conducted with large sample size and in different
settings.
A similar study can be conducted by using a qualitative approach
(phenomenological) on feelings of spouse of alcoholic dependents
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79
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Appendices
86
APPENDIX I
Ethical committee approval letter.
87
88
APPENDIX II Letter seeking permission for content validity certificate.
89
APPENDIX III
90
91
92
93
94
APPENDIX IV Informed consent form
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95
APPENDIX V
Letter seeking and granting permission to conduct the pilot study at deaddiction
centre, Government Rajaji Hospital, Madurai.
From
P.S.Rajarajendran, I year M.Sc (N), College of Nursing,
Madurai medical college, Madurai-20.
To
The Dean, Madurai Medical College, Madurai-20.
Through the proper channel,
Respected sir,
Sub: Requesting permission to conduct M.Sc (N) pilot study -reg
As per the curriculum recommended by the Indian Nursing Council and
Tamilnadu Dr.MGR Medical University all the M.Sc (N) students are required to
conduct a pilot study for the partial fulfillment of the course.
I selected the topic for my pilot study is “A study to evaluate the effectiveness
of progressive muscle relaxation technique on anxiety among spouse of alcoholic
dependents at deaddiction center, government Rajaji hospital, Madurai”.
I humbly request you to grant me permission to do my study in this setting and
complete my requirement.
Thanking you
Madurai Yours sincerely,
10-10-2014
(P.S.Rajarajendran),
96
APPENDIX VI
Letter seeking and granting permission to conduct the study at deaddiction
centre, Government Rajaji Hospital, Madurai.
From
P.S.Rajarajendran, I year M.Sc (N), College of Nursing,
Madurai medical college, Madurai-20.
To
The Dean, Madurai Medical College, Madurai-20.
Through the proper channel,
Respected sir,
Sub: Requesting permission to conduct M.Sc (N) dissertation-reg
As per the curriculum recommended by the Indian Nursing Council and
Tamilnadu Dr.MGR Medical University all the M.Sc (N) students are required to
conduct a dissertation study for the partial fulfillment of the course.
I selected the topic for my dissertation is “A study to evaluate the
effectiveness of progressive muscle relaxation technique on anxiety among spouse of
alcoholic dependents at deaddiction center, government Rajaji hospital, Madurai”.
I humbly request you to grant me permission to do my study in this setting and
complete my requirement.
Thanking you
Madurai Yours sincerely,
10-10-2014
(P.S.Rajarajendran),
97
APPENDIX VI (a)
Letter seeking and granting permission to conduct the study in deaddiction ward at GRH, Madurai
From
P.S.Rajarajendran, I year M.Sc (N), College of Nursing,
Madurai medical college, Madurai-20.
To
The Head of the Department, Department of Psychiatric, Government Rajaji Hospital, Madurai-20.
Through the proper channel,
Respected sir,
Sub: Requesting permission to conduct M.Sc (N) dissertation-reg
As per the curriculum recommended by the Indian Nursing Council and
Tamilnadu Dr.MGR Medical University all the M.Sc (N) students are required to
conduct a dissertation study for the partial fulfillment of the course.
I selected the topic for my dissertation is “A study to evaluate the
effectiveness of progressive muscle relaxation technique on anxiety among spouse of
alcoholic dependents at deaddiction center, government Rajaji hospital, Madurai”.
I humbly request you to grant me permission to do my study in this setting and
complete my requirement.
Thanking you
Madurai Yours sincerely,
10-10-2014
(P.S.Rajarajendran),
98
APPENDIX VII SECTION A
SOCIO DEMOGRAPHIC VARIABLES
Sample no: Place:
Age : Date :
1. Age
a) = 20 yrs
b) 21 yrs to 35 yrs
c) 36 yrs to 50 yrs
d) 51 yrs to 65 yrs
2. Religion
a) Hindu
b) Christian
c) Muslim
d) Others
3. Education
a) No formal Education
b) Primary Education
c) High School education
d) Higher Secondary
e) Graduate and above
4. Occupation
a) Government employee
b) Private employee
c) coolie
d) Self employment
e) House wife
99
5. Total Family Income
a) less than Rs .2000 per month
b) Rs.3001 - Rs.5000 per month
c) Rs.5001-10000 per month
d) Rs.4001-5000 per month
e) > 10000 Rs per month
6. Type of Family
a) Nuclear family
b) Joint family
c) Extended family
7. Residential
a) Rural
b) Urban
c) Semi Urban
8. No of Children’s
a) No Child
b) One Child
c) Two children
d) more than two children
9. Duration of alcohol consumption
a) less than 6 months
b) 6 months to one year
c) 1 to 5 years
d) more than 5 yrs
10. Do you have any major physical illness?
a) Yes
b) No
11. Do you practice any relaxational
techniques previously?
a) Yes
b) No
100
APPENDIX VIII
HAMILTON ANXIETY RATING SCALE
Sample number Place
Age ______________ Date _________________
TICK YOUR SYMPTOMS IN THE SUITABLE COLUMN ( )
SYMPTOMS NOTPRESENT MILD MODERATE SEVERE
VERY
SEVERE
1.Anxious mood (worries,anticipates worst)
0 1 2 3 4
2. Tension (Startles, crieseasily, restless, trembling)
3.Fears (fear of the dark, fear of strangers, fear of being alone, fear of animal)
4.Insomnia (difficulty falling asleep or staying asleep,difficulty with nightmares)
5. Intellectual ( poor concentration ,memory impairment)
6. Depressed mood (decreased interest in activities,anhedonia,insomnia)
7. Somatic complaints-muscular (muscle aches or pains,Bruxism)
8. Somatic complaints-sensory (tinnitus, blurred vision)
9. Cardio vascular symptoms (tachycardia,palpitation, chest pain,sensory of feeling faint)
101
10. Respiratory symptoms (chest pressure,choking sensation, shortness of breath)
11.Gastro intestinal symptoms (Dysphagia,nausea or vomiting,constipation, weight loss)
12. Genitourinary symptoms ( urinary frequency or urgency, dysmenorrheal, impotence)
13. Autonomic symptoms ( dry mouth, flushing, pallor,sweating)
14.Behaviour at interview ( fidgets, tremor, pases)
102
APPENDIX IX
( )
1.
) 20
) 21 35
) 36 50
) 50 65
2.
).
)
)
)
3.
)
)
)
)
)
4.
)
)
)
)
)
103
5.
) 3000
) 3000 5000
) 5000 -1���0
) 10000
6.
)
)
)
7.
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8. ?
)
)
)
)
9. ?
) 6
) 6 1
.) 1 5
) 5
10. ?
)
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11.
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)
)
104
APPENDIX X
( )
0 1 2 3 4
1. ÀÂÁ¡É ÁÉ¿¢¨Ä
(¸Å¨Ä,ÁÉ ¯¨Çîºø «¾¢¸Á¡¾ø)
2. À¾üÈõ
(±Ç¢¾¢ø «Ø¾ø,À¼À¼ôÒ)
3. ÀÂõ
(þÕ𨼠¸ñ¼¡ø,Ò¾¢ÂÅ÷¸¨Ç ¸ñ¼¡ø,¾É¢Â¡¸ þÕó¾¡ø,Á¢Õ¸í¸û)
4. àì¸Á¢ý¨Á
(¬úó¾ àì¸ò¾¢ø º¢ÃÁõ,§Àö ¸É׸ǡø º¢ÃÁõ)
5. «È¢×ò¾¢Èý
(¸ÅÉį̀È×,»¡À¸ÁȾ¢)
6. ÁÉ «Øò¾õ
(±¾¢Öõ ¬÷ÅÁ¢ý¨Á, Á¸¢ú¨Â «ÛÀŢ측¨Á, àì¸Á¢ý¨Á)
7. ¯¼ø ¾¨º À¢Ãɸû
(¾¨º ÅÄ¢,Àü¸¨Ç ¸Êò¾ø)
8. ¯¼ø ¯½÷× À¢Ãɸû
(¯¼ø «¾¢¸ ݼ¡¾ø «øÄÐ ÌÇ¢÷¾ø,Áí¸¢Â À¡÷¨Å)
9. þվ «È¢ÌÈ¢¸û
(¿¡ÊòÐÊôÒ Ì¨È¾ø,À¼À¼ôÒ, ¦¿ïÍ ÅÄ¢,ÁÂì¸ ¯½÷×)
105
10. ÍÅ¡º «È¢ÌÈ¢¸û
(¦¿ïÍ «Øò¾õ,¦¿ïÍ «¨¼ôÒ,ãîÍ Å¢Î¾Ä¢ø º¢ÃÁõ)
11. Å¢Ú-̼ø ºõÀó¾ «È¢ÌÈ¢¸û
(Å¢ØíÌž¢ø º¢ÃÁõ,Å¡ó¾¢,Å¡ó¾¢ ÅÕõ ¯½÷×,ÁÄì¸ø,±¨¼ ̨È×)
12. þÉô¦ÀÕì¸-º¢Ú¿£÷ ºõÀó¾ «È¢ÌÈ¢¸û
(«Êì¸Ê º¢Ú¿£÷ ¸Æ¢ò¾ø,Á¡¾Å¢¼¡ö ÅÄ¢,þÉô¦ÀÕì¸ þÂÄ¡¨Á)
13. ¾¡É¢ÂíÌ «È¢ÌÈ¢¸û
(Å¡ö ¯Ä÷¾ø,¦ÅǢȢ ¾ý¨Á,Å¢Â÷ò¾ø)
14. §¿÷¸¡½Ä¢ý §À¡Ð ¿¼ò¨¾
(¦ÅǢȢ Ӹõ,¨¸¿Îì¸õ,ãîÍÅ¡í̾ø)
106
APPENDIX XI
107
APPENDIX XII
108
APPENDIX XIII
PROGRESSIVE MUSCLE RELAXATION TECHNIQUE
Progressive muscle relaxation is a systematic way of teaching to managing
anxiety and achieving a deep state of relaxation. It was developed by Dr. Edmund
Jacobson in the 1930s. He discovered that a muscle could be relaxed by first tensing it
for a few seconds and then releasing it. Tensing and releasing various muscle groups
throughout the body produces a state of relaxation.
STEPS IN PROGRESSIVE MUJSCLE RELAXATION TECHNIQUE
STEP 1: Start by getting into a comfortable position.
Sit in the chair and place the feet flat on the floor, legs uncrossed .
Keep the hands resting comfortably at side or on the lap.
STEP 2:Begin by noticing breathing, noticing abdomen rise and fall with each
breath (pause after each breath).
Take a deep breath and relax yourself
Take awareness upto face
Start relaxing from the muscle of the face
STEP 3:Tense the muscles in the face
Make a sour face, like just ate a lemon.
Contract for 10 seconds, hold the face for 10 seconds seconds and relax for 20
seconds.
Repeat the process for three times.
109
STEP 4: Now, move awareness to the shoulder and neck area.
Notice the muscles in the shoulder and neck area.
Contract the muscles of the neck for 10 seconds
Press the shoulders towards the ears
Hold for 10 seconds and relax for 20 seconds.
Repeat this for 3 times.
STEP 5:Bring awareness to the muscles in the arms.
Contract the muscles of both the arms for 10 seconds by curling the arms up
towards biceps and holding them as lifting weights and holding it to chest,
hold for 10 seconds and then relax for 20 seconds.
Repeat this process for 3 times.
STEP 6:Now, bring awareness to the muscles in the hands.
Tense the muscles in the hands by clenching it into a tight fist for 10 seconds
Hold for 10 seconds and then relax for 20 seconds.
Repeat this for three times.
STEP 7:Notice the muscles in the upper back, around the shoulder blades.
Tense the muscles in the upper back for 10 seconds by pressing the shoulder
blades together
Hold for 10 seconds and then relax for 20 seconds .
Repeat this for 3 times.
STEP 8:Now, notice the muscles in the abdomen and low back.
Tense the muscles in the abdomen by filling the abdomen for 10 seconds and
holding it for 10 seconds.
110
Relax for 20 seconds .
Repeat the process for three times.
STEP 9:Now, notice the muscles in the low back.
Contact the low back muscles by pressing the low back to the chair for 10
seconds and holding it for 10 seconds
Relax it for 20 seconds.
Repeat it for 3 times.
STEP 10:Now on to the knees ,calve muscles and muscles of feet.
Tense the knee muscles by contracting the knee joint for 10 seconds
Hold it for 10 seconds and then relax for 20 seconds.
Move on to the calve muscles.
Tense the calve muscles for 10 seconds
Hold it for 10 seconds, and relax for 20 seconds.
Then make awareness on the muscles of the feet by pointing the toes towards
the knees, for 10 seconds and holding for 10 seconds ,
Relax the muscles of feet for 20 seconds.
Repeat it for 3 times
STEP 11: End the session by breathing relaxation exercises.
Take a deep breath and relax for 2 minutes
Give information regarding next session
111
APPENDIX XIV
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¬ú¿¢¨Ä ÁɾÇ÷¨Å «¨¼Â ¦ºöÔõ ´Õ ¸øŢӨȡÌõ .þÐ1930ø
ÁÕ.±ðÁñ𠃡§¸¡ôºý ±ýÀÅáø ¯ÕÅ¡ì¸ôÀð¼Ð. «Å÷ ¾¨º¸¨Ç ӾĢø
º¢Ä Ţɡʸû þÚì¸Á¡¸×õ, º¢Ä Ţɡʸû ¾Ç÷Å¡¸×õ ¨ÅìÌõ§À¡Ð ÁɾÇ÷×
²üÀθ¢ÈÐ ±ýÀ¨¾ ¸ñÎÀ¢Êò¾¡÷.¯¼Ä¢ý Àø§ÅÚ ¾¨º¸¨Ç
þÚ츢Ôõ,¾Ç÷ò¾¢Ôõ À¢üº¢ ¦ºöÔõ§À¡Ð ¯¼ø ÁüÚõ ÁÉõ ¾Ç÷Å¡¸¢ÈÐ.
¿¢¨Ä 1: þ½ì¸Á¡É ¿¢¨Ä¢ø ¬ÃõÀ¢ò¾ø
À¡¾í¸¨Ç ¾¨Ã¢ø À¾¢òÐ ,¸¡ø¸¨Ç §¿Ã¡¸ ¨ÅòÐ ¿¡ü¸¡Ä¢Â¢ø «ÁÃ
§ÅñÎõ.
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±ÖÁ¢î¨º ÀÆò¨¾ ¯ñÀЧÀ¡ø Ó¸ò¨¾ ¨Åì¸ §ÅñÎõ.
10 Ţɡʸû þÕ츢 ,10 Ţɡʸû ¿¢Úò¾¢ À¢ÈÌ 20 Ţɡʸû
¾Ç÷Å¡ì¸×õ.
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þÕ Òƒí¸¨ÇÔõ §Áø§¿¡ì¸¢ þÚ츢 ±¨¼ àìÌÅЧÀ¡ø 10 Ţɡʸû
þÕì¸×õ.
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112
Á£ñÎõ þ¨¾ 3 Ó¨È ¦ºöÂ×õ.
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þÕ §¾¡ûÀ𨼨 ´ýȡ츢 10 Ţɡʸû þÚì¸×õ
10 Ţɡʸû «§¾ ¿¢¨Ä¢ø ¨ÅòÐ À¢ý 20 Ţɡʸû ¾Ç÷ò¾×õ
þ¨¾ Á£ñÎõ ãýÚ Ó¨È ¦ºöÂ×õ.
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Å¢ü¨È ¿¢ÃôÀ¢ Å¢üÚ ¾¨º À̾¢¨Â 10 Ţɡʸû þÚ츢 À¢Êì¸×õ
þ§¾ ¿¢¨Ä¢ø 10 Ţɡʸû þÕì¸×õ
20 Ţɡʸû ¾Ç÷ò¾×õ
þ¨¾ Á£ñÎõ ãýÚ Ó¨È ¦ºöÂ×õ
¿¢¨Ä 9: À¢ý ¸£ú ÓÐÌ À̾¢¨Â ¸ÅÉ¢ì¸×õ
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À¢Êì¸×õ
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20 Ţɡʸû ¾Ç÷ò¾×õ
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ÓðÊ ±ÖõÒ þ¨½ô¨À þÚìÌžý ãÄõ Óðʨ 10 Ţɡʸû
þÚì¸×õ
10 Ţɡʸû þÚ츢 À¢ÊòÐ À¢ý 20 Ţɡʸû ¾Ç÷ò¾×õ
¸Ï측ø ¾¨º¨Â10 Ţɡʸû þÚ츢 À¢Êì¸×õ
10 Ţɡʸû «§¾ ¿¢¨Ä¢ø ¿¢Úò¾¢ À¢ý 20 Ţɡʸû ¾Ç÷ò¾×õ
À¢ÈÌ À¡¾¾¨º¸ÙìÌ ¸ÅÉõ ¦¸¡Îì¸×õ
113
¸¡ø Å¢Ãø¸¨Ç Óðʨ §Áø§¿¡ì¸¢ þÚ츢 À¢Êì¸×õ
«§¾ ¿¢¨Ä¢ø 10 Ţɡʸû ¿¢Úò¾¢ 20 Ţɡʸû ¾Ç÷ò¾×õ
þ¨¾ Á£ñÎõ ãýÚ Ó¨È ¦ºöÂ×õ
¿¢¨Ä 11:þÚ¾¢Â¡¸ ãîÍ À¢üº¢Ô¼ý ÓÊì¸×õ
¬úÍÅ¡ºò¨¾ 2 ¿¢Á¢¼í¸û ¦ºöÂ×õ
«Îò¾ À̾¢ ÀüȢ ¾¸Åø¸¨Ç ¦¾¡¢Å¢ì¸×õ
114
APPENDIX XV
Training certificate for Progressive muscle relaxation technique
115
APPENDIX XVI Photographs
Researcher collects the data from the subjects
Researcher explains the procedure to the subjects
116
Researcher demonstrates the progressive muscle relaxation technique
Subjects are redemonstrated the PMRT